Don't Use Oral Liquid Docusate Stool Softener in Any Patient, CDC Warns

Megan Brooks


July 11, 2016

US health officials are continuing to investigate a multistate outbreak of infections caused by Burkholderia cepacia complex possibly linked to contaminated oral liquid docusate stool softener products.

In its July 8 update, the Centers for Disease Control and Prevention (CDC) advised against treating any patient with oral liquid docusate products.

According to the CDC, as of July 8, 47 B cepacia complex cases have been confirmed by molecular typing to match one of two outbreak strain types identified from healthcare facilities in five states. The CDC is also looking into reports of possible cases from additional states.

The CDC has confirmed that two samples of unused oral liquid docusate product received from one of the affected hospitals have tested positive for B cepacia complex. Further testing is underway to determine whether bacteria from these samples match the outbreak strains.

In addition, the US Food and Drug Administration is conducting tests on multiple liquid docusate products that are epidemiologically linked to reported B cepacia complex cases. To date, the CDC has confirmed one product as having B cepacia complex growth.

In a preliminary update on June 24, the CDC noted that these infections have occurred primarily in ventilated patients without cystic fibrosis (CF) who are being treated in intensive care units. At that time, and again in its June 29 update, the CDC recommended that facilities not use any oral liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed.

In its July 8 update, the CDC expanded this recommendation to all patient populations. "If an oral liquid docusate stool softener is medically necessary, alternative medicines should be used," the CDC says.

The agency urges healthcare providers and laboratories to remain alert for infections caused by B cepacia complex occurring among non-CF patients and to inform infection prevention staff immediately when these infections are identified.

In addition, although infections caused by B cepacia complex are known to occur among patients with CF, any clusters of such infections should be reported. "Cases and clusters should be reported to state or local public health authorities," the CDC advises.

Facilities that identify infections caused by B cepacia complex among non-CF patients or clusters of these infections among CF patients are asked to sequester and save all docusate products used in the facility.‎‎

The CDC said it will update the situation by July 14. More information on the outbreak can be found on the CDC website.

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