An outbreak of Burkholderia multivorans associated with contaminated ice machines at acute care hospitals in California—September 2020 to February 2023
Kiara McNamara, Dipesh Solanky, Sophie Jones, Elizabeth Ohlsen, J. Bradford Bertumen, W. Wyatt Wilson, Axel A. Vazquez Deida, Mark E. Beatty, Heather Moulton-Meissner, Paige Gable, Matthew J. Arduino, John J. LiPuma, Grace Kang, Margaret M. Turner, Seema Shah, Erin Epson, Kiran Perkins, Raymond Chinn, Jane D. SiegelAbstract
Objective:
To investigate and halt transmission of Burkholderia multivorans at hospitals reporting B. multivorans outbreaks in California between September 2020 and February 2023.
Methods:
Case-patients were defined as adults without cystic fibrosis with B. multivorans isolated from any specimen source collected while an inpatient at an affected facility from January 2020 through February 2023 and confirmed as the outbreak strain by random amplified polymorphic DNA testing and repetitive extragenic palindromic polymerase chain reaction. We reviewed medical records to describe case-patients and identify common exposures; observations and staff interviews were completed to detect exposures to non-sterile water. Environmental samples and commercial products were tested for presence of B. multivorans. All B. multivorans isolates underwent whole genome sequencing.
Results:
We identified 25 case-patients. Most case-patients (n = 22, 88%) were hospitalized at the same hospital and received care in an intensive care unit (n = 17, 68%). Healthcare personnel reported using water and ice from ice machines for patient bathing, swallow evaluations, and pain relief. B. multivorans was identified from two ice machines at the hospital with the most case-patients in March 2022 and July 2022. All hospitals used the same brand of ice machine, filters, descaling, and sanitizing products. Clinical and ice machine B. multivorans isolates matched the outbreak strain.
Conclusions:
The use of water and ice from contaminated ice machines likely contributed to this outbreak. Ice machines can serve as reservoirs for Burkholderia spp. and should be investigated as sources of transmission during outbreaks of water-associated organisms in healthcare settings.