gms | German Medical Science

Bad Honnef-Symposium 2019

Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG e. V.)

29. - 30.04.2019, Bonn

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Burkholderia cepacia complex infections caused by contaminated mouthwash solutions in German hospitals in 2018

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  • Jennifer K. Bender - Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
  • Sebastian Haller - Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
  • Michael Hogardt - Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany; German National Consiliary Laboratory on Cystic Fibrosis Bacteriology, Frankfurt am Main, Germany
  • Klaus-Peter Hunfeld - Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Medical Faculty, Goethe University, Frankfurt/Main, Germany
  • Andrea Thürmer - Robert Koch Institute, MF2, Berlin Germany
  • Markus Werner - Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
  • Bernd Kunz - Mikrobiologisches Institut – Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
  • David Eisenberger - Bavarian Health and Food Safety Authority, Erlangen, Germany
  • Niels Pfennigwerth - National Reference Center for Multidrug-resistant Gram-negative Bacteria, Ruhr-University Bochum, Bochum, Germany
  • Yvonne Pfeiffer - Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
  • Volkhard A. J. Kempf - Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany; German National Consiliary Laboratory on Cystic Fibrosis Bacteriology, Frankfurt am Main, Germany
  • Guido Werner - Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
  • Tim Eckmanns - Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany

Bad Honnef-Symposium 2019. Bonn, 29.-30.04.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc19bhs09

doi: 10.3205/19bhs09, urn:nbn:de:0183-19bhs096

Published: April 25, 2019

© 2019 Bender et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: In August 2018, Burkholderia cepacia complex (BCC) infections of three patients that were associated with exposure to an octenidine mouthwash solution (MWS) were detected by Becker et al. [1]. The outbreak was reported to the Robert Koch Institute (RKI) and a nation-wide surveillance for BCC infections/colonisations associated to mouthwash exposure was implemented with parallel collection of isolates at RKI and the National Reference Center for Multidrug-resistant Gram-negative Bacteria.

Methods: All isolates were typed by SpeI-macrorestriction and pulsed-field gel electrophoresis (PFGE) in three German institutions. Furthermore, whole genome sequencing (WGS) and downstream bioinformatics analyses were carried out.

Results: We investigated 40 BCC isolates from intensive care patients and MWS of six German hospitals (isolated March–December 2018). PFGE and WGS analysis revealed that outbreaks in four hospitals were most likely due to exposure to contaminated octenidine mouthwash solutions of different batches. Analysis of the recA sequences identified B. arboris and B. cepacia as the causative species. In order to eliminate the source for further BCC infections, the entire product line was recalled immediately.

Discussion: Species of the BCC have ubiquitously been found in the environment. Members of BCC have frequently been reported as cause of nosocomial infections in critically ill patients and colonization and infections of patients with cystic fibrosis. Our analysis revealed B. arboris and B. cepacia as contaminating species of MWS bottles and subsequent colonisation and infection of patients in several hospitals despite a voluntary recall of the product in August 2018. Due to their extraordinary ability to thrive under versatile and harsh environmental conditions, medical products should be considered as a potential source when BCC species are detected amomg patients without typical risk factors. Processes of this medical product recall and quality control should be analysed and optimised.

Outline

References

1.
Becker SL, Berger FK, Feldner SK, Karliova I, Haber M, Mellmann A, Schäfers HJ, Gärtner B. Outbreak of Burkholderia cepacia complex infections associated with contaminated octenidine mouthwash solution, Germany, August to September 2018. Euro Surveill. 2018 Oct;23(42). DOI: 10.2807/1560-7917.ES.2018.23.42.1800540 External link