#4562 OUTBREAK OF RALSTONIA SPP AND BURKHOLDERIA SPP CATHETER-RELATED BLOODSTREAM INFECTION IN A HAEMODIALYSIS UNIT

Abstract Background and Aims Ralstonia (RB) Burkholderia (BB) species are environmental Gram-negative bacilli responsible for several nosocomial infections in immunocompromised or frail patients. RB BB may contaminate medical devices because of their ability to survive a biofilm with low nutrient requests. Reports infection outbreaks due very few only sporadic cases, the source contamination was identified. We describe here: i) how we managed an outbreak bacteremia caused by occurred our dialysis unit, ii) what have done identify iii) countermeasures adopted reduce risk new events. Method From 7 16 April 2021, 6 out 39 (15.4%) hemodialyzed (HD) patients long-term indwelling central venous catheter (CVC) developed symptoms related infection. Blood cultures revealed presence BB. Thus, prompt check blood all HD CVC performed. samples were incubated automated microbial detection system (VIRTUO BIOMERIEUX) subsequently, positive inoculated Chocolate Columbia Agar plates. In addition, microbiological analysis disinfectants, drugs used unit collected from reverse osmosis water (ROW) ROW delivery line None obtained resulted positive. attached on loading pipes (LP) plastic tubes (LPT) that connect hemodialyzer consoles (HC) Briefly, LTP subjected ultrasound sonication at 30-40 KHz (BactoSonic-Bandelin), disrupt bacterial biofilm. The material cultured. Bacteria identified mass spectrometry (MALDI-TOF VITEK®MS, Biomerieux). Results Bacteremia confirmed (17.9%) CVC. 1 asymptomatic. Baseline characteristics symptomatic were: mean age 68±16 years; C-reactive protein 4.48±1.3 mg/dl; procalcitonin 13.27±11.07 ng/ml; body temperature 37.9±1.4°C. antibiotic therapy decided according antibiogram included meropenem ciprofloxacin. removed infected between 11 days diagnosis. Concomitantly, one placed. arterio-venous fistulae bacteremia. isolated 37 LPT. modified order set up scheduled chemical physical disinfections hemodialysis connected avoiding LPT pipes. alternate months whole include (PE-Xa Medical Device, Fresenius Care), pipes, disinfected hot (90°C) produced heater (AquaB plus HF, Care) disinfectant, 5% peracetic acid protocols made console fabricant. added filtration module 0.01 μm (AquaUF, prior line, Figure 1. Awaiting modification dialyzed using portable treatment unit. After more than 14 production none Conclusion Our experience suggests unusual bacteria such as could be successful treated therapy. Nevertheless, should investigated adopt necessary infections.