{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:51:24Z","timestamp":1790520684457,"version":"4.1.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T00:00:00Z","timestamp":1540166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Burkholderia cepacia complex (Bcc) has caused healthcare-associated outbreaks, often in association with contaminated products. The identification of 4 Bcc bloodstream infections in patients residing at a single skilled nursing facility (SNF) within 1 week led to an epidemiological investigation to identify additional cases and the outbreak source.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A case was initially defined via a blood culture yielding Bcc in a SNF resident receiving intravenous therapy after 1 August 2016. Multistate notifications were issued to identify additional cases. Public health authorities performed site visits at facilities with cases to conduct chart reviews and identify possible sources. Pulsed-field gel electrophoresis (PFGE) was performed on isolates from cases and suspect products. Facilities involved in manufacturing suspect products were inspected to assess possible root causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An outbreak of 162 Bcc bloodstream infections across 59 nursing facilities in 5 states occurred during September 2016\u2013January 2017. Isolates from patients and pre-filled saline flush syringes were closely related by PFGE, identifying contaminated flushes as the outbreak source and prompting a nationwide recall. Inspections of facilities at the saline flush manufacturer identified deficiencies that might have led to the failure to sterilize a specific case containing a partial lot of the product.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Communication and coordination among key stakeholders, including healthcare facilities, public health authorities, and state and federal agencies, led to the rapid identification of an outbreak source and likely prevented many additional infections. Effective processes to ensure the sterilization of injectable products are essential to prevent similar outbreaks in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciy910","type":"journal-article","created":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T15:20:27Z","timestamp":1539876027000},"page":"445-449","source":"Crossref","is-referenced-by-count":25,"title":["Multistate Outbreak of Burkholderia cepacia Complex Bloodstream Infections After Exposure to Contaminated Saline Flush Syringes: United States, 2016\u20132017"],"prefix":"10.1093","volume":"69","author":[{"given":"Richard B","family":"Brooks","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Maryland Department of Health, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick K","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Pennsylvania Department of Health, Harrisburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R","family":"Miller","sequence":"additional","affiliation":[{"name":"Pennsylvania Department of Health, Harrisburg"},{"name":"Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber M","family":"Vasquez","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Havlicek","sequence":"additional","affiliation":[{"name":"Baltimore County Health Department, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lee","sequence":"additional","affiliation":[{"name":"Maryland Department of Health, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Quinn","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Albany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Adams","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Albany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Baker","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Albany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Greeley","sequence":"additional","affiliation":[{"name":"New Jersey Department of Health, Trenton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Ross","sequence":"additional","affiliation":[{"name":"New Jersey Department of Health, Trenton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irini","family":"Daskalaki","sequence":"additional","affiliation":[{"name":"Delaware Department of Health and Social Services, Dover"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Walrath","sequence":"additional","affiliation":[{"name":"Delaware Department of Health and Social Services, Dover"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Moulton-Meissner","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew B","family":"Crist","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Burkholderia cepacia Workgroup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,10,22]]},"reference":[{"key":"2019071803461376900_CIT0001","volume-title":"Burkholderia cepacia in Healthcare Settings","author":"Centers for Disease Control and Prevention"},{"key":"2019071803461376900_CIT0002","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1378\/chest.07-1545","article-title":"Multistate outbreak of Burkholderia cenocepacia colonization and infection associated with the use of intrinsically contaminated alcohol-free 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