ABSTRACT
A recent hospital outbreak related to premoistened gloves used to wash patients exposed the difficulties of defining Burkholderia species in clinical settings. The outbreak strain displayed key B. stabilis phenotypes, including the inability to grow at 42°C; we used whole-genome sequencing to confirm the pathogen was B. stabilis. The outbreak strain genome comprises 3 chromosomes and a plasmid, sharing an average nucleotide identity of 98.4% with B. stabilis ATCC27515 BAA-67, but with 13% novel coding sequences. The genome lacks identifiable virulence factors and has no apparent increase in encoded antimicrobial drug resistance, few insertion sequences, and few pseudogenes, suggesting this outbreak was an opportunistic infection by an environmental strain not adapted to human pathogenicity. The diversity among outbreak isolates (22 from patients and 16 from washing gloves) is only 6 single-nucleotide polymorphisms, although the genome remains plastic, with large elements stochastically lost from outbreak isolates.
Subject(s)
Burkholderia Infections/epidemiology , Burkholderia Infections/microbiology , Burkholderia/genetics , Genome, Bacterial , Burkholderia/cytology , Burkholderia/metabolism , Cross Infection/epidemiology , Cross Infection/microbiology , Fatty Acids/chemistry , Fatty Acids/metabolism , Humans , Switzerland/epidemiologyABSTRACT
A large outbreak of vancomycin-resistant enterococci (VRE) is affecting four hospitals in the Canton of Bern, Switzerland, since December 2017. Of 89 cases identified as carriers, 77 (86.5%) VRE isolates were virtually indistinguishable using whole genome sequencing, and identified as multilocus sequence type (MLST) ST796. This clone, previously only described in Australia and New Zealand, is characterised by rapid spread and the ability to cause bloodstream infections. It requires a multifaceted infection prevention effort.
Subject(s)
Anti-Bacterial Agents/pharmacology , Cross Infection/microbiology , Disease Outbreaks , Enterococcus faecium/classification , Enterococcus faecium/genetics , Gram-Positive Bacterial Infections/microbiology , Vancomycin Resistance/genetics , Vancomycin-Resistant Enterococci/genetics , Vancomycin/pharmacology , Adult , Cross Infection/epidemiology , Electrophoresis, Gel, Pulsed-Field , Enterococcus faecium/drug effects , Female , Gram-Positive Bacterial Infections/epidemiology , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Multilocus Sequence Typing , Switzerland/epidemiology , Vancomycin-Resistant Enterococci/drug effects , Whole Genome SequencingABSTRACT
We describe an outbreak of Burkholderia stabilis associated with contaminated washing gloves, a commercially available Class I medical device. Triggered by an increase in Burkholderia cepacia complex (BCC) bacteremias and the detection of BCC in unopened packages of washing gloves, an ad hoc national outbreak committee comprising representatives of a public health organisation, a regulatory agency, and an expert association convened and commissioned an outbreak investigation. The investigation included retrospective case finding across Switzerland and whole genome sequencing (WGS) of isolates from cases and gloves. The investigation revealed that BCC were detected in clinical samples of 46 cases aged 17 to 91 years (33% females) from nine institutions between May 2015 and August 2016. Twenty-two isolates from case patients and 16 from washing gloves underwent WGS. All available outbreak isolates clustered within a span of < 19 differing alleles, while 13 unrelated clinical isolates differed by > 1,500 alleles. This BCC outbreak was rapidly identified, communicated, investigated and halted by an ad hoc collaboration of multiple stakeholders. WGS served as useful tool for confirming the source of the outbreak. This outbreak also highlights current regulatory limitations regarding Class I medical devices and the usefulness of a nationally coordinated outbreak response.