Pseudo-outbreak of Burkholderia contaminans in a breast imaging center

In October 2024, our Clinical Microbiology Lab informed Infection Preventionists that Burkholderia contaminans had been isolated in breast biopsy specimens from two recent patients.B. contaminans is a glucose non-fermenting Gram negative bacillus within the Burkholderia cepacia complex. 1 It is commonly found in the environment and has an innate ability to survive and grow in water with only minimal nutritional sources. 2 Species within B. cepacia complex are opportunistic pathogens with intrinsic resistance to some preservatives, antiseptics, and antimicrobial agents. 3Outbreaks with B. cepacia complex have been linked to medical devices and contaminated liquids such as medications, saline, and multiuse ultrasound gel. 3,4With the availability of new technologies such as matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF, bioMerieux), microbiology labs are now better able to identify these members of B. cepacia complex to the species level.An initial investigation by Infection Prevention staff revealed that cultures from two additional patients who had breast biopsies collected the previous month were also positive for B. contaminans.All four patients had undergone breast biopsy procedures at the same hospital-based clinic.Different clinicians performed the biopsies.During the investigation, two additional patients grew B. contaminans from breast biopsies obtained in the same clinic, giving a total of six positive patients between September 2024 and November 2024.Patient histories and procedural details were obtained via chart review.Breast Imaging Clinic leadership provided detailed accounts of the biopsy procedure methods.Inquiries about disinfection of equipment, multi-use vials, and recent changes in processes or supplies were discussed.Infection Prevention staff toured the procedural area of the clinic to observe infection prevention practices.No violations were observed.Twenty-nine items, including contents of an unopened ultrasound biopsy procedure tray, tubes of non-sterile ultra-sound gel, vials of topical anesthetics, bagged IV saline, and individual wipes, were obtained from the clinic for surveillance cultures.In addition, a screw-capped tube containing 0.9% saline, which was being used to submit breast biopsy specimens for a research study, was cultured.These tubes were prepared and hand-labeled by research lab personnel.