Polyclonal outbreak of Burkholderia cepacia complex bacteraemia in haemodialysis patients M. Magalha ˜es a , C. Doherty b , J.R.W. Govan b , P. Vandamme c, * a Federal University of Pernambuco, Brazil b Department of Medical Microbiology, University of Edinburgh Medical School, Edinburgh, UK c Laboratory of Microbiology, Universiteit Gent, Ghent, Belgium Accepted 14 February 2003 KEYWORDS Burkholderia cepacia complex; Burkholderia vietnamiensis; Haemodialysis; Outbreak Summary We report a polyclonal outbreak of bacteraemia involving 24 patients at a haemodialysis facility in Recife (Brazil). During the outbreak period (4 June to 11 July, 2001), three Burkholderia cepacia complex strains were isolated from human blood and from various water samples collected at different sites in the haemodialysis unit and from dialysate fluids. Out of 14 patients with positive blood cultures, six were infected by Burkholderia cepacia complex bacteria: three with Burkholderia cepacia genomovar III, two with a first strain of Burkholderia vietnamiensis, and one with the Burkholderia cepacia genomovar III strain and a second B. vietnamiensis strain. Q 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved. Introduction Burkholderia cepacia complex bacteria are primar- ily known as serious pathogens in cystic fibrosis and chronic granulomatous disease patients, but are not a major concern in immune-competent patients. 1 However, B. cepacia complex species are notori- ously resistant to disinfectants and antiseptic solutions, and are therefore regularly seen as hospital-acquired pathogens. 2–10 In haemodialysis clinics, where this organism successfully colonizes water supplies, filter membranes, and antiseptic solutions, B. cepacia complex bacteraemia is an increasing concern. 3–5 Materials and methods Between 4 June and 11 July, 2001, two to three blood cultures were taken at intervals of 30 min from 24 febrile patients under treatment at a private haemodialysis clinic in Recife, Brazil. Blood cultures were carried out using the Bactec system (Becton Dickinson, Maryland, USA) as recom- mended by the manufacturer. Positive broth cul- tures were plated on tryptic soy agar supplemented with 5% of defibrinated sheep blood and onto eosin methylene blue medium. During the outbreak period a total of 60 samples of water and dialysate fluids were cultured quantitatively. Water samples included reservoir water, tap water from haemo- dialysis rooms, de-ionized water, (water before and after filtering) and post-osmosis water. At this haemodialysis unit, water treatment and bacterial colony counting are done in accordance with the standards of the Association for the Advancement Journal of Hospital Infection (2003) 54, 120–123 www.elsevierhealth.com/journals/jhin 0195-6701/03/$ - see front matter Q 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/S0195-6701(03)00118-X * Corresponding author. Address: Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Ledeganckstraat 35, Gent B-9000, Belgium. Tel.: þ32-9-264- 5113; fax: þ 32-9-264-5092. E-mail address: peter.vandamme@rug.ac.be