An outbreak of Burkholderia cepacia bacteremia in hemodialysis patients : An epidemiologic and molecular study

Charoen Kaitwatcharachai, Asst. Prof., D. of Internal Medicine, F. of Medicine, PSU.
Khachornsakdi Silpapojakul, Asst. Prof., D. of Internal Medicine, F. of Medicine, PSU.
Siroj Jitsurong, Asst. Prof., D. of Pathology, F. of Medicine, PSU.
Sineenart Kalnauwakul, Asst. Prof., D. of Pathology, F. of Medicine, PSU.

Published : Am J Kidney Dis 2000, 36(1) : 199-204
Key words : Burkholderia cepacia, chlorhexidine-cetrimide solution, randomly amplified polymorphic DNA (RAPD) analysis, catheter-related bacteremia

The risk of blood stream infections increases in patients undergoing chronic hemodialysis. Outbreaks of infection are usually caused by contamination of the water supply, water treatment, distribution system, or dialyzer reprocessing. We report an outbreak of subclavian catheter-related Burkholderia cepacia bacteremia in nine patients undergoing hemodialysis. Using randomly ampli-fied polymorphic DNA (RAPD) analysis, the bacterial isolates were clonally identical to Burkholderia cepacia isolated from residue of the diluted chlorhexidine-cetrimide solution used to disinfect the transfer forceps. These forceps were used to pick up cotton balls and gauze for dressing the subclavian catheter. Antibiotic therapy failed to cure the infections, and all patients required catheter removal. Pathology showed numerous bacilli embedded in the biofilm on the inner surface of the removed catheters. In conclusion, our study showed that contaminated chlorhexidine-cetrimide solution was the source of a bacteremic outbreak in nine patients who developed catheter-related Burkholderia cepacia infection.

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