Outbreak of Burkholderia cepacia bloodstream infections traced to the use of Ringer lactate solution as multiple-dose vial for catheter flushing, Phnom.

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Outbreak of Burkholderia cepacia bloodstream infections traced to the use of Ringer lactate solution as multiple-dose vial for catheter flushing, Phnom Penh, Cambodia B. De Smet, C. Veng, L. Kruy, C. Kham, J. van Griensven, C. Peeters, S. Ieng, T. Phe, E. Vlieghe, P. Vandamme, J. Jacobs Clinical Microbiology and Infection Volume 19, Issue 9, Pages 832-837 (September 2013) DOI: 10.1111/1469-0691.12047 Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1 Left: Needleless dispensing pin connected to 1L bag of Ringer lactate solution used as MDV for catheter flushing, Right: detail of dispensing pin with screw fit that was difficult to disinfect adequately. Clinical Microbiology and Infection 2013 19, 832-837DOI: (10.1111/1469-0691.12047) Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 2 Timeline of the outbreak. For patient 4 the blood culture (BC) became positive at the day of discharge. Environmental sampling included: (a) antiseptic solutions, (b) unopened stock materials for IV fluid administration and oxygen masks, (c) IV catheter and NaCl 0.9% of patient 5 and antiseptic solutions, (d) Ringer lactate multiple-dose vial and dispensing pin. Clinical Microbiology and Infection 2013 19, 832-837DOI: (10.1111/1469-0691.12047) Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 3 RAPD profiles primer 270 Left: primer 272 Right: Lanes 1 and 19: molecular size markers; lanes 2–6 and 8, 9, 11: B. cepacia blood culture isolates; lanes 7,10,11: environmental isolates (IV catheter from patient 5, Ringer lactate used as MDV, dispensing pin respectively); lane 13: B. cepacia blood culture isolate from Kampong Cham hospital; lanes 14–18: B. cepacia reference strains (see text, for Right: lane 14 is missing, but showed a distinct profile on repeat testing); lane 20: blank control. Clinical Microbiology and Infection 2013 19, 832-837DOI: (10.1111/1469-0691.12047) Copyright © 2013 European Society of Clinical Infectious Diseases Terms and Conditions