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Burkholderia cepacia complex: An outbreak in the neonatal intensive care unit of a tertiary care hospital in central India
Shayosree Sarkar, Sonal Chavan, Geetika Agrawal, Heena Rahangdale, Sunanada Zodpey,
Volume 19, Issue 4 (7-2025)
Abstract
Background: Burkholderia cepacia complex (BCC) is an opportunistic nosocomial pathogen known to cause severe infections in neonates, including those affecting the respiratory and urinary tracts, as well as bloodstream infections. Consequently, BCC has the potential to instigate outbreaks originating from various sources. This study was undertaken to facilitate the early detection and effective control of a BCC-related outbreak.
Methods: A cross-sectional study, conducted in July 2023 at a tertiary care hospital, investigated bacterial isolates from neonates. Over a one-month period, eleven neonates' blood cultures grew motile, oxidase-positive, non-fermenting gram-negative bacilli. These isolates were presumptively identified as BCC based on conventional biochemical tests and their antimicrobial susceptibility profiles. The recurring isolation of an identical bacterial strain within the neonatal intensive care unit (NICU) strongly suggested an ongoing outbreak. Consequently, active surveillance was initiated to identify the source of the infection and implement containment measures. The identity of the isolated strains was subsequently confirmed using the VITEK 2 Compact microbiology analyser (BioMérieux, France).
Results: Surveillance identified the BCC sources for all 11 affected neonates. The investigation traced the infection origins to several environmental factors within the healthcare setting, including intravenous (IV) catheters and neonatal cradles, operating theatre (OT) beds, and instrument trolleys in the labour room where the deliveries occurred. Furthermore, all environmental BCC isolates demonstrated genetic relatedness to the clinical isolates concurrently exhibiting a similar antibiotic susceptibility pattern. Timely interventions were instrumental in controlling the outbreak.
Conclusion: This study highlights the critical role of the hospital infection control team in effectively managing a BCC outbreak among neonates.

Outbreak of Burkholderia gladioli septicemia in a neonatal intensive care unit: Investigation and control measures
Karvi Agarwal , Amit Garg, Konpal Agarwal , Naila Begum ,
Volume 20, Issue 2 (3-2026)
Abstract
Background: Burkholderia gladioli (B. gladioli) is a rare but emerging pathogen associated with neonatal sepsis. This case series describes the investigation and control of an outbreak in a tertiary neonatal intensive care unit (NICU) in India.
Methods: In January 2024, seven neonates admitted to the NICU developed bloodstream infections. Clinical manifestations included respiratory distress, feeding refusal, metabolic acidosis, seizures, and shock. Predisposing factors included prematurity, congenital anomalies, and perinatal asphyxia. Blood cultures were processed using the automated BD BactecFX-40 system, and organism identification with antimicrobial susceptibility testing was performed using the BD Phoenix M-50 system. Environmental sampling was conducted to identify the outbreak source.
Results: Of 72 blood culture bottles, 34 (47.2%) flagged positive. B. gladioli were isolated from seven patients, accounting for 20.6% of positive cultures. The overall mortality rate was 57.1% (4/7 Deaths). All clinical isolates showed identical susceptibility patterns, with susceptibility to levofloxacin, cotrimoxazole, ceftazidime, chloramphenicol, minocycline, and meropenem, and intrinsic resistance to colistin. Environmental surveillance identified the same B. gladioli strain from suction apparatus and phototherapy units. Contributory factors included poor hand hygiene compliance (28-33%), limited glove availability, and overcrowding. Following cohorting, deep cleaning with 1% hypochlorite, staff retraining, and reinforcement of infection control protocols, no further isolates were recovered.
Conclusion: This outbreak highlights the high mortality associated with B. gladioli sepsis in neonates and underscores the critical need for stringent infection control practices and automated identification systems in NICUs. To our knowledge, this is the first such report from India.

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