Abstract
BackgroundWhereas Burkholderia infections are recognized to impair prognosis in cystic fibrosis (CF) patients, there is no recommendation to date for early eradication therapy. The aim of our study was to analyse the current management of initial colonisations with Burkholderia cepacia complex (BCC) or B. gladioli in French CF Centres and its impact on bacterial clearance and clinical outcome.MethodsWe performed a retrospective review of the primary colonisations (PC), defined as newly positive sputum cultures, observed between 2010 and 2018 in five CF Centres. Treatment regimens, microbiological and clinical data were collected.ResultsSeventeen patients (14 with BCC, and 3 with B. gladioli) were included. Eradication therapy, using heterogeneous combinations of intravenous, oral or nebulised antibiotics, was attempted in 11 patients. Six out of the 11 treated patients, and 4 out of the 6 untreated patients cleared the bacterium. Though not statistically significant, higher forced expiratory volume in 1 second and forced vital capacity at PC and consistency of treatment with in vitro antibiotic susceptibility tended to be associated with eradication. The management of PC was shown to be heterogeneous, thus impairing the statistical power of our study. Large prospective studies are needed to define whom to treat, when, and how.ConclusionsPending these studies, we propose, due to possible spontaneous clearance, to check the presence of Burkholderia 1 month after PC before starting antibiotics, at least in the milder cases, and to evaluate a combination of intravenous beta-lactam + oral or intravenous fluoroquinolone + inhaled aminoglycoside.
Highlights
Whereas Burkholderia infections are recognized to impair prognosis in cystic fibrosis (CF) patients, there is no recommendation to date for early eradication therapy
The Burkholderia cepacia complex (BCC) is a group of 22 closely related species belonging to the Burkholderia genus, which are capable of colonising and infecting the respiratory epithelium of cystic fibrosis (CF) patients
B. cenocepacia and B. multivorans are the main species involved in North America and most European countries including France [3,4,5,6], whereas a high prevalence of B. contaminans is observed in IberoAmerican countries [7]
Summary
Whereas Burkholderia infections are recognized to impair prognosis in cystic fibrosis (CF) patients, there is no recommendation to date for early eradication therapy. The aim of our study was to analyse the current management of initial colonisations with Burkholderia cepacia complex (BCC) or B. gladioli in French CF Centres and its impact on bacterial clearance and clinical outcome. The Burkholderia cepacia complex (BCC) is a group of 22 closely related species belonging to the Burkholderia genus, which are capable of colonising and infecting the respiratory epithelium of cystic fibrosis (CF) patients. In countries where B. cenocepacia was the most common species in the 1990s due to epidemic spread, B. multivorans currently outweighs B. cenocepacia in new infections [3, 5, 6]. The impact of B. gladioli colonisation is less clear, but abscesses and bacteraemia following lung transplantation have been reported [16, 17]. In Europe and the United States, the current prevalence and incidence of BCC infections are about 2 and 0.5%, respectively, whereas the prevalence of B. gladioli is below 0.5% [4, 6]
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