TY  - JOUR
A1  - Bender, Jennifer
A1  - Haller, Sebastian
A1  - Pfeifer, Yvonne
A1  - Hogardt, Michael
A1  - Hunfeld, Klaus-Peter
A1  - Thürmer, Andrea
A1  - Zanuzdana, Arina
A1  - Werner, Markus
A1  - Kunz, Bernd
A1  - Eisenberger, David
A1  - Pfennigwerth, Niels Ernst
A1  - Kempf, Volkhard A. J.
A1  - Werner, Guido
A1  - Eckmanns, Tim
T1  - Combined clinical, epidemiological, and genome-based analysis identified a nationwide Outbreak of Burkholderia cepacia complex infections caused by contaminated mouthwash solutions
T2  - Open Forum Infectious Diseases
N2  - Background: In September 2018, Burkholderia cepacia complex (BCC) infections in 3 patients associated with exposure to a mouthwash solution (MWS) were reported to the Robert Koch Institute (RKI). As the product was still on the market and the scale of the outbreak was unclear, a nation-wide investigation was initiated.
Methods: We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories, and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme.
Results: In total, 36 patients from 6 hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed 2 distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from 4 hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia).
Conclusions: The combined clinical, epidemiological, and microbiological investigation, including whole-genome analysis, allowed for uncovering a supraregional BCC outbreak in health care settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018, the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.
KW  - Burkholderia arboris
KW  - outbreak
KW  - clonal transfer
KW  - mouthwash solution
KW  - medical device
KW  - burkholderia
KW  - disease outbreaks
KW  - electrophoresis
KW  - gel
KW  - pulsed-field
KW  - genome
KW  - mouthwash
KW  - infections
KW  - microbial colonization
KW  - familial amyloid nephropathy with urticaria and deafness
KW  - burkholderia cepacia complex infections
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/84422
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-844221
SN  - 2328-8957
N1  - Supplementary materials are available at Open Forum Infectious Diseases online. Consisting of data provided by the author that are published to benefit the reader. The posted materials are not copyedited. The contents of all supplementary data are the sole responsibility of the authors. Questions or messages regarding errors should be addressed to the author.
N1  - This work was supported by funds from the German Federal Ministry of Health to the National Consiliary Laboratory.
VL  - 9
IS  - 5, art. ofac114
SP  - 1
EP  - 9
PB  - Oxford University Press
CY  - Oxford
ER  -