Outbreak of Stenotrophomonas maltophilia and Burkholderia cepacia Bloodstream Infections at a Hemodialysis Center.

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.

Long-term impacts of MenC vaccination campaign in the Salvador, Brazil metropolitan region: A comparison of pre- and post-vaccine periods.

The Meningococcal Serogroup C Conjugate Vaccine (MenC) was introduced into the Brazilian Immunization Program in 2010. However, in Salvador, the fourth largest capital in Brazil, an extended catch-up campaign was conducted earlier in that year, which focused on adolescents and young adults aged 10-24 years. To evaluate the long-term impact of MenC vaccination, we analyzed hospital-based surveillance data on cases of meningococcal disease in the Salvador metropolitan region during the pre-vaccine (2005-2009) and post-vaccine (2011-2016) campaign periods. Six years after the introduction of the MenC vaccine, the mean incidence rate decreased from 3.20 to 0.93 cases per 100,000 individuals (71% reduction, 95% CI [58.7-83.3]) in children <4 years. Reductions of 25.6% and 21.1% were also observed for the age groups of 5-9 and 10-14 years, respectively. On the other hand, incidence increased in the 15-24-year age group from 0.72 to 1.11, and from 0.31 to 0.60 in individuals aged >25 years (p < 0.05). At the end of the study period, serogroup C was the most prevalent (65.7%), followed by serogroups B (9.8%), W (2.3%), Y (1.6%) and A (1.0%); serogrouping was not possible in 19.6% of the cases, or adequate material was not available for serogroup identification. The use of real-time PCR from 2010 onwards increased detection rates of meningococcal meningitis by 29.6%. The long-term impact of the MenC vaccination campaign was associated with a significant reduction in MenC disease in children aged 0-4 years, yet no effect was observed in adolescents and adults, as evidenced by increasing trends in infection rates. In addition, the emergence of meningococcal serogroup A was identified, which should serve as an alert to public health officials and deserves further investigation.