An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis

Burkholderia cepacia is an important pathogen in cystic ®brosis (CF) and an infrequent cause of nosocomial infection in non-CF patients. This report describes a large hospital outbreak that appeared to involve both patient groups, a previously unrecognized phenom-enon. Ribotype restriction fragment length polymorphism (RFLP) pro®les and pulsed-®eld gel electrophoresis±resolved macrochromosomal RFLPs were analyzed, a ribotype-based phy-logenic tree was constructed, and case-control and cohort studies were performed. A single dominant clone was found in both CF and non-CF groups. Phylogenic analysis suggests that it has evolved independently and that such highly transmissible strains can emerge rapidly and randomly. Acquisition risk in the CF patients was linked to hospitalization (odds, , con®dence ±26.86) and was associated with signi®-ratio 5 5.47 P 5.0158 interval 5 1.28 cantly increased mortality rates. Infection control policies must now consider this threat of transmission between non-CF and CF patients. Burkholderia (Pseudomonas) cepacia is a nutritionally ver-satile, gram-negative organism, commonly found in soil and water. It was ®rst described in 1950 by Burkholder [1] as the phytopathogen responsible for ªslippery skin,º a bacterial ro