Abstract: TH-PO866

Burkholderia Cepacia: An Outbreak in the Peritoneal Dialysis Unit

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Gleeson, Sarah, Middlemore hospital, Auckland, New Zealand
  • Talreja, Hari Manoharlal, Middlemore hospital, Auckland, New Zealand
Background

Introduction
Burkholderia cepacia is a, gram negative, opportunistic, environmental bacillus which commonly affects cystic fibrosis and immunocompromised patients. Rarely, it can cause peritoneal dialysis exit site infection (ESI). Data on predisposing factors, clinical course and treatment options is limited. Although a common cause of nosocomial infections, no nosocomial outbreaks in peritoneal dialysis (PD) patients have previously been reported. A recent outbreak of B. cepacia ESIs in our PD unit provided a unique opportunity to gain more information on B. cepacia ESIs and to outline an approach to investigating an outbreak in the PD unit. Eight such cases were identified.

Methods

Case description
Following the identification of B. Cepacia as the causative organism in PD catheter exit site infection in three patients over an eleven week period, we began screening our PD population for B. cepacia exit site colonisation. Over the following sixteen weeks, a further three patients were identified as having asymptomatic colonisation, and a further two patients suffered symptomatic B. cepacia ESI. Of the five symptomatic ESIs, three developed tunnel infections requiring multiple courses of antibiotic treatment and eventual catheter removal. Isolated ESIs were treated with oral and topical antibiotics with full resolution.
Five of eight patients were female, three had proud flesh at the exit site, three were diabetic (all of the asymptomatic infections were in non-diabetics; two of the three tunnel infections developed in diabetic patients).
A thorough investigation into the likely source of the outbreak implicated the 4% chlorhexidine handwash used by the patients. However, samples from the manufacturer did not contain B. cepacia suggesting mishandling of the product by the patients may have contributed


Conclusion

Discussion
This is the first reported outbreak of B. cepacia PD exit site infections. A number of interesting observations were made. Firstly, diabetes may potentially be a risk factor for refractory or more extensive infection. Secondly, treatment should be individualised according to the extent of the infection; our cohort suggests that an isolated ESI can be treated successfully with oral antibiotics whereas tunnel infections generally require catheter removal.