Burkholderia Exploits the Desire for Soft Stool

One of the tell-tale smells of the hospital is the aroma of poop. The smell of poop abounds in all its varieties: infected and non-infected, formed or liquid, and any other variety you could imagine. Part of the reason for this fragrance has to do with what happens to one in the hospital: the food, the antibiotics, the infections (e.g. C.diff), and the "bowel regimens". 

Bowel regimens involve a cocktail of various medications that promote softening of the stool, act as a laxative, or both. These medications are often prescribed for ordinary constipation but also to counteract the actions of painkillers like morphine which predictably constipate patients.

An alert from the CDC issued this week, however, warns of a possible infection risk that is associated with a widely used product: the stool softener liquid docusate. The bacteria possibly associated with this product, Burkholderia cepacia complex, is one that is well-known to infectious disease physicians as a major cause of lung infections in those with cystic fibrosis. However in these cases, which appear to be confined to a single state, the patients involved do not have cystic fibrosis but are mostly critically ill ICU patients on mechanical ventilators. Because these patients are critically ill and this bacteria is difficult to treat, I suspect the mortality rate may be high.

This warning includes the recommendation that liquid docusate products not be used in critically ill patients or the immunosuppressed (other formulations of the drug are unaffected and can be used).

This outbreak underscores the well-established fact that hospitals aren't always the safest places to be. Product contamination-related outbreaks can have major consequences and be difficult to contain as products can be distributed widely and, if medical products are involved, are administered to sick patients. 

I don't think the bowel regimen will be going anywhere soon so the faster this outbreak is dissected and controlled the better.