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.

Epidemiology, microbiological, clinical characteristics, and outcome of Burkholderia cepacia complex infections in non-cystic fibrosis adult patients from Qatar

ObjectivesBurkholderia species infections are associated with diverse and challenging clinical presentations because of distinct virulence and antimicrobial resistance factors. The study aims to evaluate the epidemiology, microbiological, and clinical outcomes of Burkholderia cepacia complex (Bcc) infections in non-cystic fibrosis (CF) patients from Qatar. MethodsA retrospective study was conducted on adult patients across all hospitals at Hamad Medical Corporation between January 2012 and December 2018 to evaluate clinically relevant Bcc in non-CF adult patients. ResultsOver 7 years, 72 episodes of Burkholderia species infections were recorded, 64 were secondary to Bcc primarily affecting males (78.12%) with a mean age of 53 years, from the Middle and Southeastern region (92.2%) affected predominantly by diabetes mellitus (34.4%), chronic kidney (23.4%), coronary heart (20.3%), and hypertensive diseases (17.2%) while recent hospitalization and admission to critical care were evident in 45.3% and 93.8% of cases, respectively. Main infection sites were urinary (43.8%) and respiratory (29.7%) with associated bacteremia recorded in 26.6% of cases. Microbiological characteristics demonstrated high-level resistance profiles leading to delayed microbiological clearance in case of bacteremia (61%) and management with multiple therapeutic agents (range 4-6) resulting in disease resolution in 90.6% of cases with observed 30-day mortality of 7.8%. ConclusionsB. cepacia infections are infrequent, recorded mainly in middle-aged males with chronic comorbidities presenting as urinary, respiratory, and bacteremia associated with hospitalization, admission to critical care, and invasive procedures. High-level antimicrobial resistance is observed necessitating multiple therapeutic agents and suboptimal bacteriological clearance.

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.

Single-Center Experience of Control of Ventilator-Circuit-Transmitted Burkholderia cepacia Outbreak in an Intensive Care Unit.

Burkholderia cepacia is an emerging nosocomial pathogen frequently associated with outbreaks, but the exact transmission route of this pathogen can at times be elusive in spite of extensive environmental investigative cultures. Active surveillance for sputum cultures was performed for all patients from September 2008 to September 2009 in an intensive care unit (ICU) with B. cepacia outbreak. With evidence of persistent positive conversion of sputum cultures (colonization) and infections among patients, discontinuing re-usable ventilator circuits was introduced. A total of 689 patients were admitted to this unit for a mean duration of 8.7 ± 7.5 days. There were 489 patients (71.0%) with a stay for one to ten days; 161 (23.4%) patients for 11 to 20 days; and 39 (5.7%) with over 20 days. In the first group, 13.5% of patients had cultures converting from negative to positive, in contrast to 66.7% in the last group (p < 0.01). With intervention of using disposable ventilator circuits since June 2009, the incidence of isolated B. cepacia decreased gradually. The estimated 30-day isolation-free probabilities of the groups before, during, one month (August 2009) after, and two months (September 2009) after this intervention were 38.5%, 47.3%, 66.5%, and 96.0%, respectively (p < 0.01). Furthermore, the effect of discontinuing reusable ventilator circuit persisted in the following 6 years; both total isolates of B. cepacia and the infection caused by it were much lower compared to the outbreak period. In summary, this six-year outbreak in a medical ICU persisted until reusable ventilator circuits were discontinued in 2009. The effect of disposable circuits on the decreased incidence of B. cepacia infection maintained in the following years.

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.&#x0D; 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 BACTEREMIA PRESENTING AS SEPTIC SHOCK AND MASSIVE HEMOPTYSIS IN A PATIENT WITH SICKLE CELL DISEASE

BURKHOLDERIA BACTEREMIA PRESENTING AS SEPTIC SHOCK AND MASSIVE HEMOPTYSIS IN A PATIENT WITH SICKLE CELL DISEASE

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.

Diagnostic Uncertainty, Microbes, and the Isolation of People with Cystic Fibrosis

The framing of cystic fibrosis (CF) changed from a strictly genetic disease in the mid- to late-twentieth century to a genetic/infectious hybrid of sorts by the early twenty-first century, providing an opportunity to examine the nature of disease definition in medicine. Respiratory infections had long been associated with CF, yet it was not until the late twentieth century that many physicians became concerned about the possibility of patient-to-patient transmission of a particularly pathogenic microorganism. Initially termed Pseudomonas cepacia, the microbe was linked to rapid decline and even death in some people with CF, and early efforts to prevent its spread included the segregation of infected individuals. However, soon after segregation was implemented in a range of medical and social contexts, physicians began to suspect that people with CF did not always test positive for P. cepacia in the setting of infection, due to challenges isolating and identifying the microorganism in the laboratory. These sources of diagnostic uncertainty, coupled with the severe health outcomes associated with P. cepacia infection, prompted those in leadership positions to treat all people with CF as a potential source of contagion and restrict their in-person interactions, a practice that has had a profound impact on the CF community.

Immunization and Immunotherapy Approaches against Pseudomonas aeruginosa and Burkholderia cepacia Complex Infections.

Human infections caused by the opportunist pathogens Burkholderia cepacia complex and Pseudomonas aeruginosa are of particular concern due to their severity, their multiple antibiotic resistance, and the limited eradication efficiency of the current available treatments. New therapeutic options have been pursued, being vaccination strategies to prevent or limit these infections as a rational approach to tackle these infections. In this review, immunization and immunotherapy approaches currently available and under study against these bacterial pathogens is reviewed. Ongoing active and passive immunization clinical trials against P. aeruginosa infections is also reviewed. Novel identified bacterial targets and their possible exploitation for the development of immunization and immunotherapy strategies against P. aeruginosa and B. cepacia complex and infections are also presented and discussed.

Investigation and control of an outbreak of urinary tract infections caused by Burkholderia cepacian-contaminated anesthetic gel

BackgroundThis report describes an outbreak of 71 patients developed B. cepacia urinary tract infection (UTI) by contaminated single-use anesthetic gel.MethodsEpidemiological investigation of patients with B. cepacia-positive urine or blood samples between March 19, 2018 and Novemeber 15, 2018 was conducted to identify the source of infection. Microbiological samples from hospital surfaces, endoscopes, disposable items, and the hands of staff were tested for B. cepacia contamination. Pulsed-field gel electrophoresis (PFGE) was used to compare homology in B. cepacia isolates.ResultsDuring the outbreak, nosocomial B. cepacia UTI was confirmed in 71 patients. Epidemiological investigation showed that 66 patients underwent invasive urological diagnosis and treatment, while the remaining five patients underwent bedside indwelling catheterization, with all patients exposed to single-use anesthetic gel. All batches of anesthetic gel were recalled and the outbreak abated. Overall, 155 samples were collected from environmental surfaces and disposable items, and B. cepacia contamination was confirmed in samples from one used cystoscope and three anesthetic gels from the same batch. PFGE showed homology between 17 out of 20 B. cepacia isolates from patients and three isolates from the contaminated anesthetic gel. All patients achieved cure.ConclusionContaminated single-use anesthetic gel was confirmed as the source of the B. cepacia outbreak, with infection occurring during invasive urological diagnostic and treatments. Thus, investigations of nosocomial outbreaks of B. cepacia infection should consider contamination of diagnostic and treatment items used in infected patients.

Epidemiology of Nosocomial Bacteremia Due to Bacteria from the “&amp;lt;i&amp;gt;Burkholderia cepacia&amp;lt;/i&amp;gt; Complex” at Libreville University Hospital Center

Introduction: Burkholderia cepacia is a non-fermenting emergent bacterium common in nosocomial infections and can cause life-threatening infections whose multidrug resistance makes them a serious threat in hospitals. The aim of this study was to determine the prevalence of B. cepacia infections during nosocomial infections at Libreville University teaching hospital. Methodology: In this cross-sectional study, lasting 19 months, 412 blood cultures were analyzed. The BacT/ALERT 3D (Biomerieux, France) was used to detect the positivity of blood culture flasks and the Viteck 2 compact (Biomerieux, France) for the identification of germs and the study of their susceptibility to antibiotics. Results: Our study population consisted of 412 patients. The sex-ratio M/F was 1.06 in favor of the male gender (n = 201, 51%). The age of the patients varied between 0 and 82 years. The bacteremia of B. cepacia mainly affected children under 15 years of age with a prevalence of 7% (n = 28). The pediatric ward was more represented with a frequency of 36% (n = 10). The antibiotic sensitivity profile showed high resistance of 100% for aminoglycosides (amikacin, tobramycin, and gentamycin), tetracycline, beta-lactams (Amoxicillin, Imipenem, Ticarcillin, Cefoxitin and Cefotaxime), and ciprofloxacin. However, four molecules were active on B. cepacia (Levofloxacin 100%, Trimethoprim + sulfamethoxazole 92.3%, ceftazidime 80% and cefepime 35%). Conclusion: Ultimately, infection and multi-resistance due to Burkholderia cepacia calls for a review of hospital hygiene in the pediatric ward and a review of antibiotic therapy in young children.

Outbreak of Stenotrophomonas maltophilia and Burkholderia cepacia Bloodstream Infections at a Hemodialysis Center.

Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through polymerase chain reaction-random amplified polymorphic DNA (PCR-RAPD) and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.

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.

Bacterial blight on Dracaena sanderiana caused by Burkholderia cepacia

In 2018, severe bacterial blight was observed on Dracaena sanderiana plants imported and cultivated by a commercial nursery in Jinju, South Korea. This indoor plant is popularly grown for indoor air purification to prevent sick building syndrome (SBS). The diseased plants had severe blight symptoms, with leaf chlorosis and crumpling of stem and leaves. To identify the causal agent, we performed bacterial isolation, pathogenicity tests, physiological analysis, sequencing of the 16S rRNA region and recA gene, and phylogenetic analysis; the bacterial pathogen was identified as Burkholderia cepacia. This is the first report of bacterial blight on D. sanderiana caused by B. cepacia. Although there is no clear epidemiological information on the inoculum source, the recent occurrence of the disease indicates that B. cepacia is a potential threat to the production of indoor dracaena plants, which are increasingly used for air purification in SBS. Because D. sanderiana is grown in indoor living spaces, B. cepacia infection could threaten human health as well.

Intracellular survival and innate immune evasion of Burkholderia cepacia: Improved understanding of quorum sensing‐controlled virulence factors, biofilm, and inhibitors

Burkholderia cepacia complex (Bcc) are opportunistic pathogens implicated with nosocomial infections, and high rates of morbidity and mortality, especially in individuals with cystic fibrosis (CF). B. cepacia are naturally resistant to different classes of antibiotics, and can subvert the host innate immune responses by producing quorum sensing (QS) controlled virulence factors and biofilms. It still remains a conundrum as to how exactly the bacterium survives the intracellular environment within the host cells of CF patients and immunocompromised individuals although the bacterium can invade human lung epithelial cells, neutrophils, and murine macrophages. The mechanisms associated with intracellular survival in the airway epithelial cells and the role of QS and virulence factors in B. cepacia infections in cystic fibrosis remain largely unclear. The current review focuses on understanding the role of QS-controlled virulence factors and biofilms, and provides additional impetus to understanding the potentials of QS-inhibitory strategies against B. cepacia.

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.