BACKGROUND: No guidelines exist for the type of mouthwash that should be used in @entity1 at increased risk for @entity55 . In 2005, we investigated a multistate outbreak of @entity7081 associated with an intrinsically contaminated @entity167 -free mouthwash (AFM). METHODS: We conducted a case-series investigation. We used repetitive extragenic palindromic- polymerase chain reaction typing and pulsed-field gel electrophoresis (PFGE) to characterize available @entity6402 complex (Bcc) isolates from @entity1 and implicated AFM. Seeding studies were conducted to determine the antimicrobial activity of the AFM. RESULTS: Of the 116 @entity1 with Bcc @entity281 or colonization identified from 22 hospitals with culture dates from April 7 through August 31, 2005, 105 had @entity281 or colonizations that were due to @entity7081 . The median age of these 105 @entity1 was 64 years (range, 6 to 94 years), 52% were @entity1 , 55% had evidence of @entity281 , and 2 @entity1 died. Of 139 @entity1 culture specimens, 83 (60%) were from the respiratory tract. Among 103 Bcc @entity1 isolates characterized, 81 (76%) had an indistinguishable PFGE pattern compared to the outbreak strain cultured from implicated lots of unopened AFM; the species was @entity7081 . Seeding studies showed that the contaminated AFM might have had inadequate amounts of the antimicrobial agent @entity4410 . CONCLUSIONS: This intrinsically contaminated AFM led to a geographically dispersed outbreak of @entity7081 . AFM without therapeutic label claims is regulated by the US Food and Drug Administration as a cosmetic rather than a drug and is therefore subject to limited quality control requirements. Clinicians should be aware that AFM is not sterile. Its use in intubated and other @entity1 with increased risk of @entity1173 should be avoided.

Multistate outbreak of @entity7081 colonization and XXXX associated with the use of intrinsically contaminated @entity167 -free mouthwash.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia'] @entity167 :: ('CHEBI:16236', 'Chemical') :: ['alcohol'] @entity7081 :: ('95486', 'Species') :: ['B cenocepacia', 'Burkholderia cenocepacia'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'infections'] @entity4410 :: ('MESH:D002594', 'Chemical') :: ['cetylpyridinium chloride'] @entity6402 :: ('292', 'Species') :: ['Burkholderia cepacia'] @entity1173 :: ('MESH:D053120', 'Disease') :: ['aspiration']
@entity281 :: (MESH:D007239,Disease) :: ['infection']
