74 Burkholderia cepacia complex infection in an adult cystic fibrosis centre over a ten year period

Abstract

Objective To investigate the B. cepacia complex (Bcc) epidemiology in adult CF patients over a ten year period (2004 to 2014). Methods The hospital laboratory database was used to identify all CF patients who had Bcc isolated from at least one respiratory specimen. Results 27 patients had at least one sputum culture positive for Bcc which was molecularly confirmed. New acquisition of Bcc peaked in 2009/2010 and has fallen since. No new Bcc were isolated in 2013 or 2014. Prevalence of Bcc was 2.75% in 2004 and peaked at 7.6% in 2010. This dropped to approx 6% for the last three years. 70% of the patients were male, 30% female. Distribution of Bcc species was as follows. B. multivorans 56%, B. cenocepacia 33%, B. gladioli 7% and B. stabilis 4%. Mortality of patients over the study period ranged from 55% in B. cenocepacia to 13% in B. multivorans and 0% in B. gladioli and B. stabilis . 7 patients died in the 10 years (2 B. multivorans, 5 B. cenocepacia ). 30% of patients were culture positive on initial culture. 70% became positive on subsequent visits. PFGE was performed to out rule cross infection. For these 70% mean age of acquisition was 28. Co-infection with P. aeruginosa was the most common (52%). 3 patients were no longer culture positive for Bcc at end of study/time of death. Conclusion Mortality of patients over the 10 year period varied according to the species with B. cenocepacia having the highest mortality rate, the youngest age of acquisition and the shortest time from acquisition of organism to death. Prevalence of Bcc has remained stable for the last three years possibly due to increased life expectancy in patients and effective infection control practices.