Burkholderia cepacia complex outbreaks among non-cystic fibrosis patients in the intensive care units: A review of adult and pediatric literature.

Burkholderia cepacia complex (Bcc) is a Gram-negative bacterium commonly found in moist environments and soil. Bcc species are associated with many outbreaks in intensive care units (ICUs). In this review, we describe the sources of Bcc outbreaks among non-cystic fibrosis (CF) patients in various ICUs that include neonatal intensive care units, pediatric intensive care units and adult ICUs. Also we summarize the risk factors and outcome predictors of Bcc infection or colonization in non-CF critically ill patients. Finally, we describe the infection control measures that are used to manage and prevent the spread of Bcc outbreaks. PubMed was searched from 1 January 1994 and 31 December 2017. We found 30 outbreaks of Bcc among non-cystic fibrosis patients in ICUs; 17 outbreaks occurred in adult ICUs. The source was identified in 22 outbreaks. B. cepacia was the most common Bcc species causing outbreaks in ICUs; it was detected in 21 outbreaks. Indwelling central lines, presence of renal failure on hemodialysis, multiple bronchoscopic procedures, and recent abdominal surgery are independently associated with the development of B. cepacia bacteremia, while prolonged duration on a mechanical ventilator, a large number of nebulized albuterol therapies delivered, and prescription of beta-lactam, aztreonam, or macrolide-vancomycin antibiotics are risk factors for respiratory tract acquisition of B. cepacia. Disease severity and age were the main significant independent predictors of 14-day mortality in adult ventilated non-CF patients with Bcc acquisition. Bcc species have been linked to many outbreaks in non-CF patients in ICUs. Strict application of infection control standards is critical to limit the emergence and spread of Bcc in ICU settings.