RESUMEN
Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through polymerase chain reaction-random amplified polymorphic DNA (PCR-RAPD) and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.
Asunto(s)
Infecciones por Burkholderia/epidemiología , Burkholderia cepacia/aislamiento & purificación , Brotes de Enfermedades , Infecciones por Bacterias Gramnegativas/epidemiología , Diálisis Renal/efectos adversos , Stenotrophomonas maltophilia/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Infecciones por Burkholderia/etiología , Infecciones por Burkholderia/prevención & control , Burkholderia cepacia/clasificación , Burkholderia cepacia/genética , Desinfección/métodos , Femenino , Infecciones por Bacterias Gramnegativas/etiología , Infecciones por Bacterias Gramnegativas/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/normas , Sepsis/epidemiología , Sepsis/etiología , Sepsis/prevención & control , Stenotrophomonas maltophilia/clasificación , Stenotrophomonas maltophilia/genéticaRESUMEN
Chikungunya virus (CHIKV) has never been detected in human breast milk. This is a brief report of CHIKV infection in a breastfeeding woman of a 3-month-old baby. The mother's CHIKV-RT PCR was positive in serum, urine and milk. The baby's CHIKV serology and reverse transcription polimerase chain reaction (RT-PCR) were negative. The detection of CHIKV in milk raises clinical and epidemiologic questions.
