Research

Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit

Francisco Álvarez-Lerma¹ , Elena Maull¹ , Roser Terradas¹ , Concepción Segura² , Irene Planells³ , Pere Coll⁴ , Hernando Knobel¹ and Antonia Vázquez¹

¹Services of Intensive Care Medicine, Evaluation and Clinical Epidemiology, and Internal Medicine and Infectious Diseases, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003 Barcelona, Spain

²Service of Infectious Pathology, Laboratori de Referència de Catalunya, C/Selva 10, edifice INBLAU A, Parc de Negocis Mas Blau, E-08820 El Prat de Llobregat, Barcelona, Spain

³Service of Clinical Microbiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain

⁴Service of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, E-08025 Barcelona, Spain

author email corresponding author email

Critical Care 2008, 12:R10doi:10.1186/cc6778

Published:	31 January 2008

See related commentary by Irwin and Price, http://ccforum.com/content/12/1/115

Abstract

Background

An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described.

Methods

Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured.

Results

B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed.

Conclusion

Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections.