Ice machines can harbor water-related organisms, and the use of ice or tap water for clinical care activities has been associated with infections in health care settings. During 2021-2022, a total of 23 cases of infection by Burkholderia multivorans (sequence type ST659) were reported at two southern California hospitals and linked to contaminated ice and water from ice machines. In addition to these 23 cases, this report also includes 23 previously unreported cases of B. multivorans ST659 infections that occurred during 2020-2024: 13 at a northern California hospital, eight at a hospital in Colorado, and two additional cases at one of the southern California hospitals. The same brand of ice machine and brands of filters, descaling, and sanitizing products were used by all four hospitals; B. multivorans was isolated from samples collected from ice machines in two of the hospitals. Whole genome sequencing indicated that all clinical and ice machine isolates were highly genetically similar (0-14 single nucleotide variant differences across 81% of the selected reference genome). Recommendations from public health officials to halt the outbreak included avoiding ice and tap water during clinical care activities. An investigation is ongoing to determine possible sources of ice machine contamination. During outbreaks of water-related organisms in health care facilities, health care personnel should consider avoiding the use of tap water, including ice and water from ice machines, for patient care.

中文翻译：

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与使用制冰机中的冰和水进行患者护理活动相关的多食伯克霍尔德杆菌感染 - 加利福尼亚州和科罗拉多州四家医院，2020-2024 年。


制冰机可能含有与水相关的微生物，并且在临床护理活动中使用冰或自来水与医疗机构中的感染有关。 2021 年至 2022 年期间，南加州两家医院共报告了 23 例多食伯克霍尔德氏菌（序列类型 ST659）感染病例，这些病例与制冰机受污染的冰和水有关。除了这 23 例病例外，本报告还包括 2020 年至 2024 年期间发生的 23 例先前未报告的多食芽胞杆菌 ST659 感染病例：其中 13 例发生在北加州一家医院，8 例发生在科罗拉多州一家医院，另外 2 例发生在其中一所医院。南加州的医院。四家医院均使用同一品牌的制冰机以及同一品牌的过滤器、除垢和消毒产品；从两家医院的制冰机收集的样本中分离出 B. multivorans。全基因组测序表明，所有临床分离株和制冰机分离株在遗传上高度相似（所选参考基因组的 81% 存在 0-14 个单核苷酸变异差异）。公共卫生官员关于阻止疫情爆发的建议包括在临床护理活动中避免使用冰块和自来水。正在进行调查以确定制冰机污染的可能来源。在卫生保健机构爆发与水有关的微生物期间，卫生保健人员应考虑避免使用自来水（包括冰和制冰机的水）来护理患者。