Outbreak of Burkholderia cepacia complex in Neonatal Intensive Care Unit, Al-Rebat Hospital, Khartoum, Sudan

Background Burkholderia cepacia is a common contaminant of medical devices with the ability to persist in moist settings and resist disinfectants. It is an important opportunistic human pathogen, particularly in vulnerable patients such as those with chronic diseases and neonates. Accurate identification of B. cepacia complex (Bcc) is questionable by conventional phenotypic and biochemical methods, thereby leading to misdiagnosis of infections and serious clinical ramifications. Inadequate surveillance and identification methods are highly problematic in low- and middle-income countries (LMICs), due to limited infrastructure. We hereby describe the characterization of nosocomial Bcc outbreak involving neonates and environmental samples in a large tertiary referral hospital in Khartoum, Sudan. Case presentation: An outbreak of an uncharacterized Gram-negative bacteria was detected in the Neonatal Intensive Care Unit (NICU) of Al Ribat Teaching Hospital in Khartoum. Conventional phenotypic and biochemical methods used in routine microbiological surveillance was unable to identify the causative organism, although it displays similarities to Pseudomonas spp. A total of 72 isolates (n = 53 from septic neonates and n = 17 environmental sources) were collected from the November 2019-April 2021. 16s-23s rRNA sequencing was used for identification, followed by speciation by PCR for Bcc specific genes, and the source of outbreak was confirmed to be a common water source which was used for the ventilators, humidifier, and intravenous solutions. Upon identification of the organism and the source, infection prevention and control (IPC) was performed to clear the organism, and the outbreak was contained. Discussion Bcc are opportunistic human pathogens that are difficult to characterize by conventional methods.. In this case report, we highlight the importance of using molecular detection methods for rapid and accurate outbreak characterization. We recognize the difficulty in routine implementation of molecular identification in resource-limited settings such as Sudan, which consequently requires increased capacity strengthening and support, yet highlight the importance of employing advanced diagnostic tools in managing outbreaks in high-risk settings to achieve optimum IPC measures.