Burkholderia cepacia infection Outbreak in three hospitalization areas of San Juan de Dios Hospital – Santa Ana, El Salvador, January to March 2022.

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  • Anti-microbial resistance
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The San Juan de Dios Hospital (SJDH) is a regional referral hospital. From January to March 2022, Burkholderia cepacia was reported in 21 bacteriological cultures. This is an opportunistic pathogen in immunosuppressed patients, difficult to control due to its intrinsic ability to generate resistance to antibiotics. Objectives: characterize the cases, identify possible sources of contamination, mode of transmission and implement control measures.
Cross-sectional descriptive study. Case definition: “Any person who, after an invasive procedure or wound cleaning, presents abdominal pain and/or discharge, during January-March 2022, while hospitalized in nephrology, medicine and surgery units in SJDH”. Cases were confirmed by isolation of B. cepacia by culture. To identify the agent, cultures were taken from patients, the environment (walls, electronic devices, disinfectant solutions) and dialysis equipment. Frequencies, proportions, rates, epidemic curves were calculated. Microsoft Excel and R Studio were used for the analysis.
A total of 21 cases were investigated. The agent was confirmed in 21(100%) of cases. Median age 55 years; 11(52%) were male. Main symptom: abdominal pain 12 (57.1%). Comorbidities: chronic kidney disease in 18(85.7%), 2(9.5%) Diabetes Mellitus and 1(4.8%) pneumonia. All cases are healthcare-associated infections, with 14(66.7%) of infections at the peritoneal catheter insertion site. Invasive procedures performed: placement of soft catheter 14(66.7%), Mahurkar catheter 3(14.3%), 1(4.8%) central venous catheter and bladder catheter, respectively. In 2(9.5%) cases, soft tissue injuries were healed. 21(100%) were immunosuppressed. B. cepacia was isolated in chlorhexidine gluconate solution culture.
Chlorhexidine was identified as source of infection through process of asepsis and antisepsis with chlorhexidine. Elimination of the antiseptic and quality control of sealed gallons was implemented. Monthly cultivation of disinfectant solutions, environmental cultures for monitoring and terminal cleaning of nephrology areas is recommended.

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