Dr. Twishi Shrimali is a Consultant and Assistant Professor in Clinical Microbiology at Amrita Hospitals, Faridabad. She holds an MD in Microbiology from AIIMS Jodhpur and a Fellowship in Paediatric Infectious Diseases from Chacha Nehru Bal Chikitsalaya, GGSIPU. Her professional expertise includes clinical microbiology, infectious diseases, antimicrobial resistance, infection prevention and control, and antimicrobial stewardship. She has contributed to numerous national and international conferences, workshops, and academic activities and has authored multiple publications in the fields of infectious diseases, medical mycology, microbiology, and antimicrobial resistance.

Caffeine Citrate as an Unusual Source of Burkholderia cenocepacia Outbreak in a Neonatal Intensive Care Unit: Insights from Molecular Epidemiology:                                      

Background: 

Burkholderia cenocepacia is an opportunistic pathogen that can cause healthcare-associated infections, particularly in vulnerable patient populations. We investigated an outbreak of B. cenocepacia sepsis in a neonatal intensive care unit (NICU), with a focus on identifying the source and establishing the relatedness of clinical and environmental isolates.

A prospective outbreak investigation was conducted in August 2023 in a 30-bedded NICU. Blood cultures from affected neonates and extensive environmental samples were processed using standard microbiological methods. Isolates were identified by MALDI-TOF MS and antimicrobial susceptibility testing was performed. Whole-genome sequencing (WGS) using the Oxford Nanopore MinION platform was undertaken to assess the genetic relatedness of clinical and environmental isolates. Genome-based phylogenetic analysis was performed using the MINTyper package.

Five preterm neonates developed sepsis, with B. cenocepacia isolated from blood cultures in all cases. Environmental surveillance identified B. cenocepacia in sterile water, ventilator condensate, Cheatle forceps, and in-use caffeine citrate vials. However, repeat sampling demonstrated persistent contamination only in the caffeine citrate vials, implicating them as the likely outbreak source. Clinical and environmental isolates showed similar antimicrobial susceptibility patterns. WGS-based phylogenetic analysis demonstrated close genetic relatedness among the clinical and environmental B. cenocepacia isolates. No mortality was observed among the affected neonates.

his outbreak highlights caffeine citrate as an unusual and potentially overlooked source of B. cenocepacia transmission in the NICU. Identification of the source required integration of epidemiological investigation, repeated environmental sampling, conventional microbiology, and molecular epidemiology. The findings underscore the importance of pharmaceutical surveillance, stringent infection prevention practices, and genomic tools in investigating and controlling healthcare-associated outbreaks.

Keywords: Burkholderia cenocepacia; NICU outbreak; neonatal sepsis; caffeine citrate contamination; molecular epidemiology; infection control