Burkholderia Cepacia Infection Research Articles

A rare case of urinary tract infection by Burkholderia cepacia

Burkholderia cepacia is a motile, aerobic, non-fermentative, gram-negative bacillus and has been widely documented as a lung pathogen in patients with cystic fibrosis and chronic granulomatous disease. It is documented as an important emerging cause of multi-drug resistant nosocomial infections, and an important cause of morbidity and mortality. A 64-year-old male patient visited the Nikea Primary Healthcare Center, Piraeus, Greece, referred by the family doctor (GP), for follow-up due a history of prostate cancer (patient on immunosuppression) and recurrent UTIs with subsequent admission to the hospital. Patient history revealed diabetes mellitus type 2, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, history of recurrent UTIs, with 4 hospitalizations in a tertiary hospital during the last 2 years, prostatic hypertrophy, 2 episodes of prostatitis before the diagnosis of prostate cancer Gleason score 6, at the end of 2019, with subsequent total prostatectomy, and radiotherapy. Patient history also revealed dysuria, frequent urination, pain and burning sensation during urination and erectile dysfunction. Urinalysis showed intense pyuria, abundance of micro-organisms and abundance of red blood cells. The urine culture grew monomicrobial Burkholderia cepacia 105 CFU/ml. The bacterium was identified by the RapID™ REMEL ONE identification system (Thermo Fisher Scientific). Antimicrobial susceptibility testing revealed susceptibility to antibiotics such as, Ceftazidime, Ciprofloxacin, Norfloxacin, Levofloxacin and Imipenem.The patient received treatment with Levofloxacin. Burkholderia cepacia infections outside the respiratory system are rare. Moreover, recurrent UTIs with B. cepacia is a rare finding, which highlights the importance of our study. UTIs with B. cepacia have been associated with bladder irrigation or use of contaminated hospital objects and liquids. B. cepacia is one of the most antimicrobial-resistant organisms and treatment options are limited. The patient was treated with Levofloxacin (3rd generation fluoroquinolone — Tavanic) 500 mg daily per os for 2 weeks, due to his history.

Efficacy of Antibiotic Bone Cement in the Treatment of Burkholderia cepacia Infection After Spinal Internal Fixation Surgery: Case Report and Literature Review

In recent years, the number of spinal internal fixation operations has increased significantly, correlating with an elevated risk of postoperative surgical site infection and a rising incidence rate. While the conventional treatment approach involves surgical debridement combined with antibiotic administration, there is a notable gap in reported strategies for Burkholderia cepacia infection and patients exhibiting multidrug resistance. Surgical site infection occurred in a patient following internal fixation surgery for thoracic vertebral fractures. Despite the application of systemic antibiotics and regular dressing changes, no improvement was observed. Bacterial culture and drug sensitivity experiments revealed a multidrug-resistant Burkholderia cepacia infection. Two comprehensive debridement procedures were performed along with continuous post-operative irrigation combined with antibiotic administration; however, no significant improvement was observed. The patient's infection was significantly controlled following treatment with vancomycin loaded bone cement. Following spinal internal fixation surgery, the management of a B.cepacian infection with multidrug resistance presented a significant challenge, despite the application of debridement procedures and systemic antibiotics. In this case, after 20days of treatment with vancomycin-loaded bone cement, the patient's C-reactive protein level decreased to 54mg/L, was normalized by February, and normal levels were maintained in the surgical area 1month and 6months after bone cement removal. The use of vancomycin-loaded bone cement proves effective in treating postoperative B.cepacian infection in a multidrug-resistant case following spinal internal fixation surgery.

Burkholderia cepacia infections at sites other than the respiratory tract: A large case series from a tertiary hospital in Madurai

Sparsely reported extrapulmonary Burkholderia cepacia complex (Bcc) infections highlights the importance of this study. This was a retrospective chart review of 37 patients with extrapulmonary Bcc infections admitted between December 2019 and July 2022 in a tertiary hospital. Males accounted for 70% of cases. 78% had atleast one underlying comorbid illness. Among 37 isolates, 22 were from blood, others include exudates, urine and peritoneal fluid. Susceptibility rates of ceftazidime, meropenem, minocycline, cotrimoxazole and levofloxacin were 88, 88, 70, 65.7 and 56.7% respectively. Eleven died of septic shock and 24 patients (64.8%) had good outcomes, while two were lost to followup.

A Case of Burkholderia cepacia Sepsis in a postpartum patient with colonic perforation due to Ogilvie's syndrome: Case from a tertiary care hospital in Bangladesh

Traditionally known as a nosocomial organism and preponderance to infect the immunocompromised patients or withpreexisting structural damage in lung parenchyma1, Burkholderia cepacia infection in an apparentlyimmunocompetent host in ICU settings is not very commonly heard of. On the other hand, acute colonicpseudo-obstruction (Ogilvie’s syndrome) is also a very rare surgical complication. Here we present a case of apostpartum lady who developed colonic perforation following caesarean section due to Ogilvie’s syndrome andBurkholderia cepacia sepsis and eventually expired.
 Bangladesh Crit Care J March 2023; 11 (1): 43-45

Burkholderia cepacia infection in children without cystic fibrosis: a clinical analysis of 50 cases.

Burkholderia cepacia (B. cepacia) is an emerging pathogen of nosocomial infection in pediatric patient carrying cystic fibrosis. The clinical diagnosis and treatment of B. cepacia infection remains poorly studied. This study outlined the risk factors, antimicrobial susceptibility, and clinical characteristics aiming to improve the treatment of B. cepacia infection. A retrospective study was conducted based on the 50 cases infection caused by B. cepacia in children without cystic fibrosis, which were diagnosed in the First Affiliated Hospital of Xiamen University, from January 1st, 2011 to December 31st, 2021. A total of 50 children were infected with B. cepacia, of whom 68% had an underlying health condition, such as cardiovascular disease (23.5%), respiratory disease (17.6%), nervous system disease (14.7%), and neoplastic disease (14.7%). At the onset of B. cepacia infection, 42 (84%) pediatric patients were in an intensive care unit (ICU), 33 (66%) underwent endotracheal intubation, and 32 (64%) had a central venous catheter (CVC). In addition, hospital-acquired cases were 46 (92%), and healthcare-acquired cases were 4 (12%). The most common infectious sites of B. cepacia were the respiratory tract (68%), followed by the blood (20%), and the urinary tract (12%). It indicated that B. cepacia was the most sensitive to ceftazidime (95.65%), followed by trimethoprim-sulfamethoxazole (88.68%), meropenem (82.98%), cefepime (77.78%), and levofloxacin (55.85%). The drug resistance rate of piperacillin-tazobactam, minocycline, aztreonam, cefoperazone-sulbactam and ceftriaxone was higher than 55%. 38 cases were cured or improved, eight had treatment terminated, and four died. B. cepacia is an opportunistic pathogen normally found in immunocompromised pediatric patients and highly likely to lead to drug resistance. Nosocomial B. cepacia infections occurred mostly in patients in the ICU based on our observations. The surveillance of B. cepacia infections including changing epidemiology and increasing resistance of the microorganism is still very important. Treatment with effective antibiotics such as ceftazidime, meropenem, trimethoprim-sulfamethoxazole is associated with a favorable prognosis.

A Rare Case of successfully treated Double Valve Infective Endocarditis Due to Burkholderia cepacia Infection

A Rare Case of successfully treated Double Valve Infective Endocarditis Due to Burkholderia cepacia Infection

Lentiviral gene therapy for X-linked chronic granulomatous disease recapitulates endogenous CYBB regulation and expression

AbstractX-linked chronic granulomatous disease (X-CGD) is a primary immunodeficiency caused by mutations in the CYBB gene, resulting in the inability of phagocytic cells to eliminate infections. To design a lentiviral vector (LV) capable of recapitulating the endogenous regulation and expression of CYBB, a bioinformatics-guided approach was used to elucidate the cognate enhancer elements regulating the native CYBB gene. Using this approach, we analyzed a 600-kilobase topologically associated domain of the CYBB gene and identified endogenous enhancer elements to supplement the CYBB promoter to develop MyeloVec, a physiologically regulated LV for the treatment of X-CGD. When compared with an LV currently in clinical trials for X-CGD, MyeloVec showed improved expression, superior gene transfer to hematopoietic stem and progenitor cells (HSPCs), corrected an X-CGD mouse model leading to complete protection against Burkholderia cepacia infection, and restored healthy donor levels of antimicrobial oxidase activity in neutrophils derived from HSPCs from patients with X-CGD. Our findings validate the bioinformatics-guided design approach and have yielded a novel LV with clinical promise for the treatment of X-CGD.

Burkholderia cepacia Infections at Sites Other than the Respiratory Tract: A Large Case Series from a Tertiary Referral Hospital in Lebanon

ObjectivesThe Burkholderia cepacia complex (Bcc), which was originally thought to be a single species, represents a group of 24 distinct species that are often resistant to multiple antibiotics, and usually known to cause life-threatening pulmonary infections in cystic fibrosis patients. Herein we describe a series of non-respiratory Bcc infections, the risk factors and epidemiologic factors, in addition to the clinical course.Patients and methodsThis is a retrospective chart review of 44 patients with documented B. cepacia infections isolated from sites other than the respiratory tract admitted between June 2005 and February 2020 to the American University of Beirut Medical Center (AUBMC), a tertiary referral hospital for Lebanon and the Middle East region. The epidemiological background of these patients, their underlying risk factors, the used antibiotic regimens, and the sensitivities of the B. cepacia specimens were collected.ResultsThe majority of the Bcc infections (26/44, 59.1%) were hospital-acquired infections. The most common nationality of the patients was Iraqi (18/44, 40.9%), and the most common site of infection was bacteremia (17/44, 38.6%), followed by skin and soft tissues infections (16/44, 36.4%) and vertebral osteomyelitis (8/44, 18.2%). Most of the isolated B. cepacia were susceptible to ceftazidime, carbapenems, followed by TMP-SMX. Patients responded well to therapy with good overall outcome.ConclusionsBcc can cause infections outside the respiratory tract, mostly as hospital-acquired infections and in immunocompromised patients. Most patients were referred from countries inflicted by wars raising the possibility of a potential role of conflicts which need to be investigated in future studies. Directed therapy according to susceptibility results proved effective in most patients.

Antimicrobial Resistant Streptococcus pneumoniae Infections: Clinical and Epidemiological Trends

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Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: An integrative review.

To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). Integrative review. A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). In total, we reviewed 125 documented outbreaks of Burkholderia cepacia-related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.

Investigation of Nosocomial Cluster Infections of Peripheral Venous Catheter-Related Bloodstream Infection

Object: Determine the cause of nosocomial cluster infections of peripheral venous catheter-related bloodstream infection (PIVC-BSI), and provide advice on prevention, control and nursing measures. Method: A retrospective analysis of nosocomial cluster infections that occurred in a tertiary hospital on July 28-30, 2019. Blood samples from patients suspected of PIVC-BSI were retained for bacterial culture. The clinical data of the patients, environmental hygiene indicators were collected. Results: All 8 patients had chills within 0.5 - 3.5 hours after intravenous infusion, and the highest body temperature reached 41°C. The peripheral blood samples of 4 patients were cultured as Burkholderia cepacia infection, and the eluate from the catheter tip of 2 patients cultured the same bacteria as the blood culture. The humidity in the treatment preparation room was 60% - 80%. There was mold in the sterile storage cabinet. Conclusion: The nosocomial cluster infection of PIVC-BSI was caused by Burkholderia cepacia colonizing the tip of the peripheral intravenous catheter, and the high air humidity was the most likely factor. The ability of nurses to identify and respond to PIVC-BSI as well as the infection control management level of each department still needs to be improved.

Nosocomial Burkholderia cepacia infection in a tertiary hospital; Five-year surveillance: A retrospective cross-sectional study

Amac: Burkholderia cepacia, glikozu fermente edemeyen aerobik, Gram-negatif ve cok ilaca direncli bir bakteridir. Immunsuprese hastalarda onemli bir firsatci bakteri olan Burkholderia cepacia, ciddi pulmoner enfeksiyonlara neden olur. Bu calismada, son bes yilda tespit edilen Burkholderia cepacia vakalarini degerlendirmeyi amacladik. Yontemler: Calisma retrospektif olarak planlandi. Calismaya 2013-2018 yillari arasinda ucuncu basamak hastanedeki 46 B. cepacia olgusu dahil edildi. Yas, cinsiyet, klinik oyku, alinan ornek tipi, hastalarin son durumu (yasiyor veya olu) ve hastanede yatis suresi kaydedildi. Bulgular: Orneklerin dagilimi incelendiginde, kan kulturunde %32,6 (n=15), idrar kulturunde %32,6 (n=15), trakeal aspiratta %17.4 (n=8) bulundu. Hastalarin son durumlari yasiyor veya olu olarak degerlendirildi. Buna gore, olgularin %65,2’sinin (n=30) yasadigi, %34,8’inin (n=16) ise oldugu tespit edildi. Olgularin kliniklere gore dagilimi incelendiginde, anestezi %19,6 ile (n=9) ilk siradaydi. Hastanede kalis suresi ortalama 24,6 ± 25,3 gundu (minimum-maksimum: 3-122 gun). Sonuc: Burkholderia cepacia onemli bir nozokomiyal firsatci enfeksiyondur ve siklikla cok ilaca direnclidir. Bu sebeple hastalik etkin bir sekilde tedavi edilmelidir aksi halde hastaligin mortalite ile sonuclanacagi unutulmamalidir.

Designing Probes for Immunodiagnostics: Structural Insights into an Epitope Targeting Burkholderia Infections

Structure-based epitope prediction drives the design of diagnostic peptidic probes to reveal specific antibodies elicited in response to infections. We previously identified a highly immunoreactive epitope from the peptidoglycan-associated lipoprotein (Pal) antigen from Burkholderia pseudomallei, which could also diagnose Burkholderia cepacia infections. Here, considering the high phylogenetic conservation within Burkholderia species, we ask whether cross-reactivity can be reciprocally displayed by the synthetic epitope from B. cenocepacia. We perform comparative analyses of the conformational preferences and diagnostic performances of the corresponding epitopes from the two Burkholderia species when presented in the context of the full-length proteins or as isolated peptides. The effects of conformation on the diagnostic potential and cross-reactivity of Pal peptide epitopes are rationalized on the basis of the 1.8 Å crystal structure of B. cenocepacia Pal and through computational analyses. Our results are discussed in the context of designing new diagnostic molecules for the early detection of infectious diseases.

Heterogeneity in Survival in Adult Patients With Cystic Fibrosis With FEV1 < 30% of Predicted in the United States

Lung transplantation (LTx) is frequently considered for patients with cystic fibrosis (CF) when the FEV1 reaches< 30%. This study estimated transplant-free survival for patients with CF and an FEV1< 30%and identified predictors of death without LTx. We conducted a retrospective cohort study using the CF Foundation Patient Registry from January 1, 2003 to December 31, 2013. Adult patients (≥ 18 years) with FEV1< 30%prior to LTx were included. We performed Kaplan-Meier survival estimates censored at LTx. Multivariable Cox proportional hazard regression identified predictors of mortality. There were 3,340 patients with an FEV1< 30%. Death without LTx occurred in 1,250 patients (37.4%); 951 patients (28.5%) underwent LTx; 918 patients (27.5%) remained alive without LTx at the end of follow-up; and 221 patients (6.6%) were lost to follow-up. Median transplant-free survival after FEV1< 30%was 6.6 years (95%CI, 5.9-7.0). Adjusted predictors of death without LTx included supplemental oxygen use (hazard ratio [HR], 2.1; 95%CI, 1.7-2.6), Burkholderia cepacia infection (HR, 1.8; 95%CI, 1.3-2.6), BMI≤18 (HR, 1.6; 95%CI, 1.3-1.9), female sex (HR, 1.6; 95%CI, 1.2-2.0), CF-related diabetes in patients receiving insulin (HR, 1.4; 95%CI, 1.2-1.8), and≥ one exacerbation per year (HR, 1.7; 95%CI, 1.3-2.2 vs. 0 exacerbations). Median survival was > 6.5 years for patients with CF and an FEV1< 30%, exceeding prior survival estimates. There was substantial heterogeneity in survival, with some patients with CF dying soon after reaching this lung function threshold and others living for many years. For this reason, we conclude that FEV1< 30%remains an important marker of disease severity for patients with CF. Patients with a supplemental oxygen requirement or frequent exacerbations should have prompt referral because of their increased risk of death.

Risk of cardiac pacemaker pocket infection in a tertiary care hospital.

The risk of pacemaker pocket infections (PPIs) is rare with good antisepsis techniques and use of advanced antibiotics. However, injudicious antibiotic usage leads to the rise of multidrug-resistant bacteria, which may cause PPI. Few reports exist about the microbial spectrum of the PPI from our country, prompting us to study the same. We conducted this retrospective observational study for 3 years (January 2013-February 2016) from all the patients with PPI. We collected the relevant clinical samples (blood and pus) for the microbial culture using a standard protocol. We included 100 samples collected from the medical staff and the hospital environment as a control sample. The data were analyzed using appropriate statistical methods and a P< 0.05 was considered statistically significant. Our data showed that 17 out of 160 (10.6%) patients had PPI. Coagulase negative Staphylococcus sp. was isolated in 7 (41.2%) patients, followed by Staphylococcus aureus in 4 patients (23.5%). Other isolated bacteria include multidrug-resistant Burkholderia cepacia (n = 3), Mycobacterium abscessus (n = 2) and polymicrobial infection in a single patient. One out of hundred surveillance samples grew B. cepacia. Our data revealed a high incidence of Gram-positive cocci causing PPI. Every hospital should formulate their antibiotic policy based on the pattern of the hospital flora and their drug sensitivity.

Burkholderia cepacia infection in an infant affected by renal osteodystrophy

We report a case of chronic osteomyelitis caused by &lt;em&gt;Burkholderia cepacia&lt;/em&gt; presenting with multiple bone localizations in an infant affected by end-stage renal disease. In order to avoid the amputation of the extremities, a salvage procedure was attempted: all lesions were curetted completely and filled in with bone cement. At 24 months follow-up all lesions are completely healed.

Is the type of chronic pulmonary infection a determinant of lung function outcomes in adult patients with cystic fibrosis?

Lung function abnormalities are the main factors responsible for the high mortality of cystic fibrosis (CF) patients. It is not yet clear whether Burkholderia cepacia infection causes more pronounced loss of lung function than pseudomonas aeruginosa infection. Our primary objective was to compare the lung function of adult CF patients with different chronic pulmonary infections. Our second objective was to compare the microbiology using patients' genetic status. Fifty-two adult CF patients were divided into 3 groups according to their chronic pulmonary infection profile. All subjects underwent clinical evaluation, pulmonary function tests (PFT) and genetic analysis. The PFT parameters of chronically infected patients were significantly different from those of subjects without pulmonary infection (p < 0.0001). FVC was significantly more altered in patients infected with B. cepacia complex (p < 0.0001); in contrast, FEF25-75% was significantly more altered in patients with P. aeruginosa infection (p < 0.0001). In the groups with chronic P. aeruginosa infection and chronic B. cepacia complex infection, 58.1% and 10% of patients were homozygous for AF508, respectively. In addition to chronic infections, pancreatic insufficiency was also associated with lung function deterioration. Chronic pulmonary infection and pancreatic insufficiency are critical processes in lung function deterioration in adult CF patients. Although chronic B. cepacia complex infection causes a more pronounced lung volume reduction, chronic P. aeruginosa infection causes a more pronounced obstruction of small airways. Our results also suggest that deltaF508-homozygous patients are more susceptible to chronic P. aeruginosa infection.

Burkholderia Sepsis in Children as a Hospital-Acquired Infection.

PurposeHospital-acquired Burkholderia cepacia (B. cepacia) infection are not commonly recorded in patients without underlying lung disease, such as cystic fibrosis and chronic granulomatous disease. However, in 2014, B. cepacia appeared more frequently in pediatric blood samples than in any other year. In order to access this situation, we analyzed the clinical characteristics of B. cepacia infections in pediatric patients at our hospital.Materials and MethodsWe conducted a retrospective study of blood isolates of B. cepacia taken at our hospital between January 2004 and December 2014. Patient clinical data were obtained by retrospective review of electronic medical records. We constructed a dendrogram for B. cepacia isolates from two children and five adult patients.ResultsA total of 14 pediatric patients and 69 adult patients were identified as having B. cepacia bacteremia. In 2014, higher rates of B. cepacia bacteremia were observed in children. Most of them required Intensive Care Unit (ICU) care (12/14). In eleven children, sputum cultures were examined, and five of these children had the same strain of B. cepacia that grew out from their blood samples. Antibiotics were administered based on antibiotic sensitivity results. Four children expired despite treatment. Compared to children, there were no demonstrative differences in adults, except for history of ICU care.ConclusionAlthough there were not many pediatric cases at our hospital, awareness of colonization through hospital-acquired infection and effective therapy for infection of B. cepacia is needed, as it can cause mortality and morbidity.

Burkholderia cepacia infection of the prostate caused by inoculation ofcontaminated ultrasound gel during transrectal biopsy of the prostate

Burkholderia cepacia infection of the prostate is very rare. We report 6 cases of prostatic infection secondary to inoculation of contaminated ultrasound gel during transrectal biopsy of the prostate. All of these patients required hospitalization and were treated with intravenous antibiotics. One of these cases is the first description of chronic prostatitis with B. cepacia.

A rare case of community acquired Burkholderia cepacia infection presenting as pyopneumothorax in an immunocompetent individual

Burkholderia cepacia ( B. cepacia) infection is rarely reported in an immunocompetent host. It is a well known occurence in patients with cystic fibrosis and chronic granulomatous disease where it increases both morbidity and mortality. It has also been included in the list of organisms causing nosocomial infections in an immunocompetent host, most of them transmitted from the immunocompromised patient in which this organism harbors. We report a rare case of isolation of B. cepacia from the bronchoalveolar lavage fluid of an immunocompetent agriculturist who presented with productive cough and fever associated with a pyopneumothorax. This is the first case of community acquired infection reported in an immunocompetent person in India.