burkholderia cepacia transmission

(2001). eCollection 2020. The triple antimicrobial combination of meropenem, high-dose tobramycin (200  µg/mL, achievable by aerosol administration), and a third antibiotic were bactericidal against 81%-93% of 191 multidrug-resistant B. cepacia complex isolates from cystic fibrosis patients (2). [PubMed], 69. Infect Control Hosp Epidemiol 2014;35 Suppl 1:S1-S67. Spilker In vitro Pharmacodynamics of Levofloxacin and Other Aerosolized Antibiotics Under Multiple Conditions Relevant to Chronic Pulmonary Infection in Cystic Fibrosis. Sun L, Jiang RZ, Steinbach S, et al. This edition is an updated, revised and greatly expanded guide to the classes of organisms that infect humans. Resistance to β-lactam agents is most commonly mediated by constitutively expressed or inducible chromosomal β lactamases or efflux pumps (68). Only B. cepacia complex isolates belonging to species other than B. cenocepacia were included in the study. Transmission of Burkholderia cepacia during hospital patients are A-H and J; the adult patients L-P and R. PCR, partially barrier-nursed. Evidence of inter-patient spread of strains belonging to other B. cepacia complex species is more limited. For surface inoculation, bacteria were suspended in phosphate buffered saline, sputum from CF patients, or sputum from persons without CF. Saiman L, Siegel JD, LiPuma JJ, et al. Epidemic transmission of B. cenocepacia strains among both cystic fibrosis and non-cystic fibrosis patients has been associated with two genetic markers, cable pilin subunit (cblA) that promotes respiratory colonization by binding the abnormal cystic fibrosis respiratory mucin and the … Nzula S, Vandamme P, Govan JR. The taxonomy of Burkholderia (formerly Pseudomonas) cepacia complex currently consists of 18 distinct bacterial species with a wide environmental distribution in soil and plants, especially the underground stem (rhizome) (Table 1) (63, 73) . J Infect Dis 2010;201:264-71. T.L. Further, we deliberately set a relatively high similarity coefficient cutoff value with which to define strain types in this study. J.F. LiPuma C. B.E. Generally, it produces nosocomial infection due to contamination of disinfectants, medical equipment, prosthetic material and drugs, such as anesthetics or liquids used in urological irrigation. K. Resistance to trimethoprim is mediated by production of dyhydrofolate reductase or acquisition of outer membrane antibiotic efflux pumps that confer cross resistance to chloramphenicol and fluoroquinolones (7). (, Segonds [PubMed], 51. Witzmann Since the early 2000s, several B. cepacia outbreaks have been caused by contaminated medical products. Eur J Clin Microbiol Infect Dis 2009;28:1275-1279. O'Neil KM, Herman JH, Modlin JF, Moxon ER, Winkelstein JA. Study isolates were further limited to include only those from treatment centers wherein at least six patients were infected with the same B. cepacia complex species. Antimicrob Agents Chemother 2003;47:400-4. We sought to identify strains from B. cepacia complex species other than B. cenocepacia that are similarly shared by multiple CF patients. N. Only two centers were identified that cared for six or more B. cepacia-infected patients, but in both we found shared strains. In center E, the same strain infected six of 17 B. multivorans-infected patients. cepacia’ among CF patients.. Infect Control Hosp Epidemiol 2011;32:804-10. (, Coenye Checkerboard MIC testing using two-drug combinations appears to have limited utility in designing treatment regimens for cystic fibrosis patients with multiply-resistant B. cepacia complex (18, 75). For serious infection with susceptible strains, a two-drug combination of parenteral trimethoprim-sulfamethoxazole (5 mg/kg trimethoprim component every 6-12 hr) plus a β-lactam (e.g., ceftazidime, piperacillin, meropenem) or a fluoroquinolone should be utilized. LiPuma For full access to this pdf, sign in to an existing account, or purchase an annual subscription. M. Management of pulmonary disease in patients with cystic fibrosis. Tigecycline is variably active in vitro due to efflux-mediated resistance and clinical experience is limited (12, 48). Burkholderia cepacia is a rare cause of sepsis in newborns and its transmission involves human contact with heavily contaminated medical devices and disinfectants. In vitro activity of ceftazidime+NXL104 against Pseudomonas aeruginosa and other non-fermenters. Found inside – Page iThis volume offers extensive information on preventive and infection surveillance procedures, routines and policies adapted to the optimal infection control level needed to tackle today’s microbes in hospital practice. Zhou J, Chen Y, Tabibi S, Alba L, Garber E, Saiman L. Antimicrobial susceptibility and synergy studies of Burkholderia cepacia complex isolated from patients with cystic fibrosis. Multiple combination bactericidal antibiotic testing for patients with cystic fibrosis infected with Burkholderia cepacia. T. [21] were also subsequently found to be B. multivorans[22,23]. Coenye No meropenem resistant B. cepacia complex strains were cultured at the end of treatment compared to 5 of 14 strains resistant to meropenem before therapy. McCarter LL: Regulation of flagella. 1C) implicated in the first reports of inter-patient spread and inapparent (i.e. Murray Burkholderia (Pseudomonas) cepacia is an important pathogen amongst persons with cystic fibrosis (CF), and evidence suggests that transmission of strains within CF clinics contributes to pulmonary colonization of some patients. In contrast, Mahenthiralingam et al. Avgeri SG, Matthaiou DK, Dimopoulos G, Grammatikos AP, Falagas ME. Burkholderia cepacia is a Gram-negative bacillus that is widely distributed in nature; it is isolated from the ground, water, plants and vegetables. B. cepacia complex isolates from patients with cystic fibrosis are generally substantially more resistant than are isolates from non-cystic fibrosis patients, a finding that likely reflects the both prior parenteral, oral, and nebulized antimicrobial exposure and differences in the distribution of the B. cepacia complex species among the patient populations (41). P. 307 It is closely related to Pseudomonas mallei, P. pseudomallei, P. pickettii, and other Pseudomonas species that are plant pathogens. B. Burkholderia cepacia has become an increasingly recognized pathogen among cystic fibrosis (CF) patients and its potential role in declining pulmonary function or unexpected fatal outcome has caused widespread concern. B. cepacia’s emergence as a pathogen coincided with social and medical grouping of CF patients in specialized units, clinics, and social groups. A clinical trial of tobramycin inhalational powder in cystic fibrosis patients infected with B. cepacia complex is pending enrollment as of August 2014 (clinicaltrials.gov identifier NCT02212587). cepacia’ in CF in the early 1990s [24,25]. Bylund J, Campsall PA, Ma RC, Conway BA, Speert DP. Transmission of Burkholderia (Pseudomonas) cepacia by close contact with colonized patients is well documented, and minimizing social contact between cystic fibrosis (CF) patients by segregation and cohorting of B. cepacia colonized patients has achieved some success in controlling the nosocomial and community spread of this organism. H.J. (, Vandamme G.B. transmission between non-CF and CF patients. [PubMed], 61. Nelis In vitro activity of doripenem against Pseudomonas aeruginosa and Burkholderia cepacia isolates from both cystic fibrosis and non-cystic fibrosis patients. The strain involved in an outbreak among pediatric CF patients in Glasgow described by Whiteford et al. Mahenthiralingam E, Simpson DA, Speert DP. Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA. The initial empiric antimicrobial regimen for with invasive infections in a patient with chronic granulomatous disease should include trimethoprim-sulfamethoxazole (5 mg/kg trimethoprim component every 6 hours) and ceftazidime or a similar agent with broad spectrum antimicrobial activity. Optimal management of B. cepacia complex infection associated with indwelling medical devices, including central venous catheters and central nervous system shunts, requires removal of the device in addition to directed antimicrobial therapy (53, 56). Tomich M, Herfst CA, Golden JW, Mohr CD: Role of flagella in host cell invasion by Burkholderia cepacia. American journal of respiratory and critical care medicine 2000;161:1206-12. In cystic fibrosis patients with B. vietnamiensis pulmonary infection, aminoglycoside or azithromycide therapy has been associated with emergence of aminoglycoside resistance via induction of active drug efflux  (33). Author information: (1)Department of Pediatrics and Communicable Diseases, University of … B. cepaciafrom contaminated medicines and devices has been reported. In addition, at 24 weeks the B. cepacia MIC50 increased 4 fold compared to baseline in the nebulized aztreonam arm but was unchanged in the placebo arm. 2. [PubMed], 44. Among the 360 patients assessed in the study reported here, most (319 patients) were infected with B. multivorans, which accounts for approximately 38% of B. cepacia complex-infected CF patients in the USA [7]. Clin Diagn Lab Immunol 8, 509-514]. The genomovar status of these isolates was determined by a polyphasic approach, which included whole-cell protein electrophoresis and recA … Drug selection should be guided by MCBT testing to avoid the substantial risk of antagonism with two-drug combinations (2) . Bethesda, MD 20894, Help Meropenem, ceftazidime, minocycline, temocillin, and piperacillin/tazobactam appear to have the greatest activity in vitro against B. cepacia complex isolates from patients with cystic fibrosis (Table 2) (75). Found insideThe 2003 Red Book, 26th Edition advances the Red Book's mission for the 21st century, with the most current information on clinical manifestations, etiology, epidemiology, diagnosis, and treatment of more than 200 childhood infectious ... ET12 and several, but not all, other ‘epidemic’B. 1C). cepacia’. Radomski K.A. Confirmation of identification, speciation, and molecular typing of epidemiologically important B. cepacia complex isolates should be performed at a reference laboratory. [PubMed], 29. S.D. [PubMed], 19. Bacteria belonging to the Burkholderia cepacia complex are important pathogens in persons with cystic fibrosis (CF). Airborne dissemination of Burkholderia (Pseudomonas) cepacia from adult patients with cystic fibrosis. [PubMed], 43. Members of the B cepacia complex are opportunistic gram-negative nosocomial pathogens that can cause serious infections in immunocompromised patients and newborns. 63. Y. Brashimy These three strains, as well as several other ‘epidemic’ strains reported by Mahenthiralingam et al. A cluster of seven patients infected with the same B. cepacia (genomovar I) strain was found. Advance praise for Salt in My Soul "This is a deeply moving book full of wisdom about health, life, and love--and about the importance of finding happiness wherever and whenever we can. Pediatric Pulmonology 2000;29:210-2. Found insideThis book provides a comprehensive overview of the multisystem disease, cystic fibrosis, for both pediatric and adult patients. Gilligan In a more recent report, the three-drug combination of high-dose tobramycin, meropenem, and a third agent—either piperacillin-tazobactam, ceftazidime, trimethoprim-sulfamethoxazole, or amikacin, was active in vitro against half of 47 multidrug-resistant biofilm-grown B. cepacia complex isolates (18,). Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak. The B. cepacia complex is currently comprised of nine species, B. cepacia, B. multivorans, B. cenocepacia, B. stabilis, B. vietnamiensis, B. dolosa, B. ambifaria, B. anthina, and B. pyrrocinia (representing genomovars I–IX, respectively) [3–6]. (, Johnson Found insideThis book includes a collection of interesting chapters contributed by eminent scientists around the world who have been striving to improve the life of those affected by CF. 1A); this strain has been designated strain OHBM. Furthermore, PFGE analysis using published interpretive criteria [13] confirmed the clonality of the isolates we placed in the same strain type by BOX-PCR analysis. Recommendations to prevent transmission of epidemiologically important pathogens among patients with cystic fibrosis were updated recently (63). J Cyst Fibros 2006;5:121-4. Among the eight patients in the first center were three patients infected with a common strain. Although information about the treatment of pulmonary B. cepacia infection in cystic fibrosis therapy is limited, several conclusions can be drawn: 1) multidrug-resistant strains and frequent in vitro antagonism between agents make empiric therapy problematic; 2) bactericidal, two-or three-drug antimicrobial combinations should be administered with choice of agents guided by a combination susceptibility testing method; and 3) clinical response may be observed in the absence of bacteriologic response. This book presents in an easy-to-read format a summary of the important central aspects of microbial glycobiology, i.e. the study of carbohydrates as related to the biology of microorganisms. Dales L, Ferris W, Vandemheen K, Aaron S. Combination antibiotic susceptibility of biofilm-grown <i>Burkholderia cepacia</i> and <i>Pseudomonas aeruginosa</i> isolated from patients with pulmonary exacerbations of cystic fibrosis. Wilkinson R.D. E. G. Antimicrob Agents Chemother 1996;40:772-5. Burkholderia cepacia is now considered one of the most important pathogen in CF patients. In addition, he has been described as a cause of pneumonia in patients with chronic granulomatous disease and as a nosocomial pathogen in immunocompetent patients. The transmission is airborne as a rule. R. [PubMed], 76. These investigators subsequently documented person-to-person transmission of B. cepacia among individuals attending an educational program for young adults with CF. LiPuma Antimicrob Agents Chemother 2014;58:5211-9. Clin Infect Dis 1992;14:1078-83. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. Reinfection, rather than persistent infection, in patients with chronic granulomatous disease. These differences potentially were related to the more widespread and uniform particle delivery to the lungs by aerosolization compared to intranasal administration and to the aspiration of intranasal phage particles into the stomach. J Antimicrob Chemother 2001;48:549-52. These isolates clustered by BOX-PCR with a similarity coefficient of 94% (Fig. Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. (, Pitt Found inside – Page 201Evidence of transmission of Burkholderia cepacia, Burkholderia multivorans and Burkholderia dolosa among persons with cystic fibrosis. Abstract. Meropenem and doripenem have greater activity in vitro against B. cepacia complex than imipenem or ertapenam (11, 12, 67). We also identified a large group of 28 patients receiving care in the same treatment center and infected with the same Burkholderia dolosa strain. The prevalence increases with age and varies widely between cystic fibrosis centers. Chest 2005;128:2336-46. Despite these findings, based upon the goals of reducing bacterial density, virulence factor production, and airway inflammation and potentially limiting the risk of emergence of resistance on therapy, cystic fibrosis patients with pulmonary exacerbations associated with B. cepacia complex should receive combination therapy. Cohn RC, Rudzienski L. In vitro suppression of Pseudomonas cepacia after limited exposure to subinhibitory concentrations of amiloride and 5-(N,N-hexamethylene) amiloride. Burkholderia cepacia isolates of genomovar III are highly transmissible amongst patients with cystic fibrosis (CF) and express a 97 kDa putative haem-binding protein (HBP) [Smalley, J. W., Charalabous, P., Birss, A. J. Porter LA, Goldberg JB. Conlon T. LiPuma JJ, Spilker T, Gill LH, Campbell PW, 3rd, Liu L, Mahenthiralingam E. Disproportionate distribution of Burkholderia cepacia complex species and transmissibility markers in cystic fibrosis. Found inside – Page 1Clinical Pancreatology Since the book Clinical Pancreatology for Practising Gastroenterologists and Surgeons was first published sixteen years ago, the knowledge and clinical management of pancreatic diseases have developed markedly. Consecutive outbreaks of BURKHOLDERIA CEPACIA complex caused by INTRINSICALLY Contaminated Chlorhexidine mouthwashes. In a study of 119 multidrug-resistant B. cepacia complex isolates from 59 patients in 17 geographically dispersed cystic fibrosis centers, 50% of the isolates were resistant to all single drug and 8% to all two-drug combinations tested (3). Clinical studies comparing the various agents in the treatment of B. cepacia complex infection are largely limited to uncontrolled case series, especially among patients who do not have cystic fibrosis (4, 38). a novel member of the Burkholderia cepacia complex comprising biocontrol Person-to-person transmission of Pseudomonas cepacia between patients and cystic-fibrosis related isolates. The variable ability of novel b-lactamase inhibitors to restore the in vitro activity of ceftazidime may be related to the relative prevalence of b lactamase- versus efflux-mediated resistance in clinical B. cepacia complex isolates (50). [PubMed], 9. We performed genotype analysis of 360 recent sputum culture isolates from 360 persons residing in 29 cities by using repetitive extragenic palendromic polymerase chain reaction (rep-PCR) and pulsed field gel electrophoresis. Would you like email updates of new search results? In this book leading international investigators review key advances in Burkholderia research to provide timely overview. It was first described in 1950 by Burkholder [1] as the phytopathogen responsible for “slippery skin,” a bacterial rot … Aerosol phage therapy warrants additional study in the treatment of multidrug-resistant B. cepacia complex pulmonary infection. According to the U.S. Cystic Fibrosis Foundation’s 2012 National Patient Registry, 2.6 percent of all persons with cystic fibrosis were infected with B. cepacia complex compared to 3.1% in 2005 (1). M. The organism was first described in 1950 as causing a “soft rot” in onions. J.R.W. Hoste D. The emergence of a highly transmissible lineage of cbl+ Pseudomonas (Burkholderia) cepacia causing CF centre epidemics in North America and Britain. Zlosnik JE, Costa PS, Brant R, Mori PY, Hird TJ, Fraenkel MC, Wilcox PG, Davidson AG, Speert DP. This transmission is a ... investigate Burkholderia cepacia complex (Bcc) infections. More interesting was the single center that cares for multiple patients infected with B. dolosa. J. Microbiologyopen. cepacia’ among CF patients. In contrast to chronic B. cepacia complex infection in persons with cystic fibrosis that typically is associated with persistence of a single strain type, recurrent B. cepacia complex infection in persons with chronic granulomatous disease is usually caused by a new strain (26). These data demonstrate that (1) B. cepacia can survive for long periods in respiratory droplets on environmental surfaces typically found in CF clinics, (2) undefined factors in sputum from patients with CF may contribute to survival of B. cepacia, and (3) strain-to-strain variation in survival time may affect strain transmissibility. LiPuma Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit. T. This observation, as well as the finding that most strains are inherently resistant to broad-spectrum antibiotics, has made prevention of infection a cornerstone of CF patient management [2]. Therapeutic options for Burkholderia cepacia infections beyond co-trimoxazole: a systematic review of the clinical evidence. Candida auris. PHARYNGITIS DUE TO BURKHOLDERIA CEPACIA. Kaufmann Recently, B. delosa strain SLC6 caused a large outbreak of B. cepacia complex infection among pediatric and adult patients at a large US cystic fibrosis care center (34). A better understanding of the epidemiology and ecology of these species is a prerequisite to optimizing infection control policies and is essential in efforts to elucidate the pathogenesis of human infection. 2020 May 15;15:Doc10. Davies (, Vandamme Mahenthiralingam Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis. GMS Hyg Infect Control. Segonds et al. B. cepacia complex is often resistant in vitro (MIC >256  mg/mL) to concentrations of tobramycin achieved by nebulization of solution (54). International J Antimicrobial Agents 2009;34:402-6. D.P. Caraher E, Reynolds G, Murphy P, McClean S, Callaghan M. Comparison of antibiotic susceptibility of Burkholderia cepacia complex organisms when grown planktonically or as biofilm in vitro. Of these, BCSA agar is the most useful in supporting the growth of B. cepacia complex and suppressing the growth of other organisms. Our data also indicate that the possibility of inter-patient transmission of non-B. In the present study, in which only intra-center comparisons were made of strains recovered during relatively short periods of time, a higher cutoff was necessary to provide a more rigorous definition of clonality. L. The epidemiologic basis of our findings and their implications for infection control and clinical outcome are not entirely clear. Other putative virulence factors, include regulated gene expression by quorum sensing, exopolysaccharide production associated with the mucoid phenotype that promotes evasion of the host response and persistence, and lipopolysaccharide that contributes to immune-mediated tissue damage. Although B. cepacia complex are highly resistant to both fosmidomycin and colistin in vitro, fosmidomycin decreased the colistin MIC up to 64-fold to as low as 8 mg/mL in checkerboard MIC assays, a concentration achievable by inhalational therapy (44).