Burkholderia cepacia lower respiratory tract infection associated with exposure to a respiratory therapist

OBJECTIVE: To investigate and control a nosocomial outbreak of Burkholderia cepacia lower respiratory tract infection. DESIGN: Outbreak investigation and case-control study. SETTING: A 260-bed community hospital. PATIENTS: Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive for B cepacia between January 1 and November 6, 1998. METHODS: Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-con trol study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit. RESULTS: Nine case-patients were identified; B cepacia likely caused pneumo nia in seven and colonization in two. Two respiratory therapy practices pro bably contributed to the transmission of B cepacia: multidose albuterol via ls were used among several patients, and nebulizer assemblies often were no t dried between uses. B cepacia was grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns of B cep acia from seven case-patients and two multidose vials were indistinguishabl e. Case-patients had longer durations of heated humidified mechanical venti lation (mean, 9.8 days vs 4.4 days; P=.03) and were more likely to have exp osure to one particular respiratory therapist than controls (odds ratio, un defined; 95% confidence interval, 4.7-infinity; P=.001). The association wi th the respiratory therapist, a temporary employee, persisted after control ling for duration of heated humidified ventilation. No new B cepacia infect ions were identified after control measures were implemented. CONCLUSIONS: B cepacia probably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therap y departments must pay close attention to infection control practices, part icularly among new or temporary staff (Infect Control Hosp Epidemiol 2001;2 2:423-426).