Burkholderia cenocepacia is an environmental Gram-negative bacterium, resistant to many antibiotics and antiseptics, that can survive in aqueous hospital environments. We investigated an outbreak of B. cenocepacia in the intensive care unit (ICU) of Ng Teng Fong General Hospital, aiming to identify the source and prevent further transmission.

The outbreak was detected after two ICU patients developed B. cenocepacia bacteremia. Environmental samples, including ultrasound gels, and disinfectants, were collected. Whole genome sequencing (WGS) was used to determine clonality between clinical and environmental isolates. Immediate actions were taken, including a recall of ultrasound gel batches and the use of sterile gel sachets for high-risk procedures.

Ultrasound gels from opened and unopened bottles from multiple hospital areas, including ICU and Radiology, were found to be contaminated with B. cenocepacia, with a specific batch (Brand A) linked to the outbreak. WGS analysis confirmed the genetic relatedness of clinical and environmental isolates. A hospital-wide recall of affected gel batches was implemented. Through our regional networks, notification of countries in our immediate region along with alerting our local health authorities for further investigation was also undertaken. Additionally, we continued surveillance of gels and identified further contaminated products.

This outbreak highlights the risks of contaminated medical products, specifically ultrasound gels. Effective environmental sampling, rapid identification, and clear communication with health authorities were key to controlling the outbreak. We have since revised our protocols to mandate the use of sterile gel for invasive procedures and continue monitoring for potential contamination in ultrasound gels.

To describe Candida auris infections from two different geographical regions within a large health-system, both of which have experienced a significant increase in the occurrence of C. auris.

Multicenter, retrospective, descriptive analysis across a large healthcare system.

Patients were included in this study if they were admitted as an inpatient between January 1, 2021 and September 30, 2022 and had a clinical specimen that grew C. auris.

A total of 321 patients were included. The clinical outcomes of included patients were comparable between geographical regions (Western and Eastern), with the exception of patients who experienced mortality or transitioned to hospice care at discharge (Western 32.1% vs Eastern 19.1%, P = .014). Over one-third of patients required mechanical ventilation at any point during their admission, while greater than half of the total study population had receipt of a blood transfusion. Approximately 25.2% of all patients received hemodialysis, while 24.3% received total parental nutrition during their hospital stay. More than 50% of patients in both regions required an admission to the intensive care unit at any time-frame during their stay. Fluconazole-resistant isolates were more prevalent in the Western region, but both regions demonstrated a high prevalence of resistance.

Patients identified with C. auris were characterized by significant underlying morbidity and disease burden. Further studies are warranted to identify infection prevention best practices to reduce transmission and reduce mortality through earlier identification and appropriate antifungal therapy.