https://www.lucidchart.com/publicSegments/view/086067ab-7881-4e1d-8018-7dd57d0f9856

1. SARA GONZÁLEZ FRANCO
TERCER SEMESTRE / BIOLOGÍA MOLECULAR /
FACULTAD DE MEDICINA UPB

2. INTRODUCTION
• B cepacia is an aerobic, nonfermenting,
gram-negative bacillus. It is rich in wet soil,
water, plants, and animals in the
environment. Moreover, it is often found in
the hospital environment (it is one of the
etiologies of nosocomial infections).
.It has been found also in polluted
water, pipes, and instruments in
hospitals. Many studies have
reported outbreaks of nosocomial B
cepacia infections caused by the
contamination of drugs or devices.

3. INTRODUCTION
• Thus, it has been reported to cause outbreaks
of hospital infections.Immunocompromised
patients, such as those with cystic fibrosis and
chronic granulomatosis, are primarily infected.
https://shoppri.files.wordpress.com/2016/06/cystic-fibrosis.jpg

4. GENERAL OBJECTIVE
• Investigate an outbreak of Burkholderia
Cepacia infection caused by drug
contamination in a tertiary hospital in China.

5. METHODS
• Microbiology investigation
When the first case was
reported, the drug was
believed to be the source of
infection.
The hospital infection control
and prevention staff used
sterile swabs with sterile
saline solution to collect
samples from the
environment, object surfaces,
and hands. Moreover,
samples of unopened drugs
were sent for microbiologic
testing. All the bacteria were isolated by using the following methods…

6. METHODS
• PFGE
Pulsed-field gel electrophoresis (PFGE) is a
laboratory technique used by scientists to
produce a DNA fingerprint for a bacterial
isolate
The DNA fragments produce a DNA fingerprint
with a specific pattern. The figure shows an
example of an agarose gel where each lane
represents a DNA fingerprint or pattern.
Once a DNA fingerprint is created, they
investigate the pattern to see if it is causing an
outbreak or it is part of an ongoing outbreak.
http://1.bp.blogspot.com/-uhe7mD5EqOE/VpNSWsFgbzI/AAAAAAAAF9k/-KEMuUB93Bc/s1600/1.jpg

7. METHODS
• VITEK
It is a system that uses cards with colorimetric
reagents, which are inoculated with the
suspension of a pure microbial culture and
the development profile is interpreted
automatically.
Reactive cards have 64 wells that each contain
an individual test substrate
Types of cards:
1. GN - Gram negative bacilli fermenters and non-
fermenters.
2. GP – Gram positive cocci and bacilli-forming bacilli
3. YST - Yeasts and yeast organisms
4. BCL - Gram-positive spore-forming bacilli
It is used for microbial identification and antibiotic
sensibility tests
http://2017.igem.org/wiki/images/3/33/T--Sheffield--HP_vitek2_edited.png

8. METHODS
• Susceptibility
With the test, the discs are impregnated with various defined
concentrations of different antibiotics are placed onto the
surface of the agar. A multichannel disc dispenser can speed up
placement of the discs. After incubation (16–24 h at 35 °C) zones
of growth inhibition around each of the antibiotic discs are
measured to the nearest millimeter. A clear circular zone of no
growth in the immediate vicinity of a disc indicates susceptibility
to that antimicrobial. the size of zone can be related to the MIC
and results recorded as whether the organism is susceptible (S),
intermediately susceptible (I), or resistant (R) to that antibiotic.
It was used to now if Burkholderia’s isolates were susceptible or resistant.

9. RESULTS
Several batches of
unopened drugs were
sampled
• Among surgical
instruments, B cepacia
was isolated from 2
(20%) of the 10 grilles
used for perineal
prostate biopsy
• 8 samples of unopened
analgesic gel were
obtained from 5
different batches, of
which 2 were positive
for B cepacia. The
positivity rate was
100%.

10. RESULTS
A total of 9 patients in the urology ward were positive for B cepacia from January 2017 to March 2018. The incidence
rate of nosocomial infection caused by B cepacia from January to October 2017 was 0.00%, where as that from
November 2017 to March 2018 was 0.43% (9/20967), there by confirming the outbreak

11. RESULTS
• 3 patients presented with
underlying chronic conditions, the
remaining 6 patients were healthy
• Symptoms of infection included
fever in 5, dysuria and perineal
pain in 1, and fever with dysuria
and perineal pain in 1 patient and
2 patients were asymptomatic.
• All patients had undergone a
surgery before symptom onset.
• B cepacia was isolated from urine
specimens of 9 patients, of which
2 showed B cepacia in the blood

12. RESULTS
The homology of bacteria isolated
from patient specimens and analgesic
gel was determined using pulsed-field
gel electrophoresis.
• M line: Labeled
• Line #1: specimens of patients
without B cepacia infection
• Lines #2-11: specimens of patients
with B cepacia infection
• Lines #12-13: analgesic gel samples
All isolations from patients and drugs
were homologous

13. DISCUSSION
AUTHOR Mencioned by the article YES OR NOT
State Pharmacopoeia
Committee
“The control bacteria of urethral nonsterile
chemicals in Chinese pharmacopoeia were S
aureus, P aeruginosa, and Candida albicans,
but there was no B cepacia
Peterson AE, et al. “Immunocom- promised patients, such as
those with cystic fibrosis and chronic
granulomatosis, are primarily infected.”
Moehring RW, Akinboyo
IC, Shaban RZ, Hutchinson
J, et al.
The causes of contamination included water
pollution during production product design
defects that lead to improper disinfection,
and the presence of bacteria resistant to
preservatives in products.

14. CONCLUSSIONS
• The investigation revealed that the outbreak of
B cepacia infection was caused by drug
contamination
• B cepacia should be added to the list of
controlled bacteria for drug microbiologic
monitoring under supervision