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Research Square Jul 2023To report the clinical characteristics, antibiotic susceptibilities, and review the literature of complex () associated endophthalmitis.
PURPOSE
To report the clinical characteristics, antibiotic susceptibilities, and review the literature of complex () associated endophthalmitis.
STUDY DESIGN
Retrospective, observational case series.
METHODS
Clinical and microbiology records were reviewed for patients evaluated at the Bascom Palmer Eye Institute and diagnosed with culture-confirmed endophthalmitis due to . Antibiotic susceptibility profiles were generated using standard microbiologic protocols via an automated VITEK system.
RESULTS
Endophthalmitis associated with BCC was diagnosed in three patients. Infection occurred in the setting of post-penetrating keratoplasty (PKP), glaucoma filtering surgery, and suspected trauma. All isolates demonstrated susceptibility to ceftazidime and meropenem. Presenting visual acuity (VA) ranged from hand motion to light perception. Initial treatment strategies included intravitreal ceftazidime (2.25 mg/0.1 mL) and vancomycin (1.0 mg/0.1mL) injections with fortified topical antibiotics in 2 patients, and surgical debridement of a corneoscleral melt with patch graft along with both topical fortified antibiotics oral antibiotics in the third patient. In all 3 patients, there was no VA improvement at last follow-up, as 2 eyes ultimately underwent enucleation and 1 eye exhibited phthisis bulbi at last follow-up. BCC related endophthalmitis was reviewed among 13 reports. Treatment outcomes were generally poor and antibiotic resistance was common. These BCC isolates cases demonstrated broad resistance patterns, with susceptibilities to ceftazidime (58%), ciprofloxacin (53%), and gentamicin (33%).
CONCLUSIONS
Endophthalmitis caused by is a rare clinical entity with generally poor visual outcomes despite prompt treatment with appropriate antibiotics.
PubMed: 37503162
DOI: 10.21203/rs.3.rs-3181158/v1 -
Infectious Diseases in Clinical... May 2019prosthetic valve endocarditis (PVE) is extremely rare, with few cases in the literature. A report of a patient with PVE is described, followed by a literature review on...
prosthetic valve endocarditis (PVE) is extremely rare, with few cases in the literature. A report of a patient with PVE is described, followed by a literature review on PVE. A 38 year old man with poor dentition and a history of intravenous drug use (IVDU) and mitral valve replacement was found to have a mitral valve vegetation. Five sets of blood cultures on different days grew . Individual sets of blood cultures on different dates also isolated (outside hospital culture), methicillin-resistant (hospital day 1), and (hospital day 6). He was successfully treated with ceftazidime and levofloxacin as dual therapy for PVE, in addition to vancomycin for gram positive coverage. This case report and review highlights the possibility of PVE in immunocompetent patients with poor dentition, with the potential for a successful outcome following combination antimicrobial therapy.
PubMed: 31467470
DOI: 10.1097/IPC.0000000000000708 -
The Cochrane Database of Systematic... Jan 2016Chronic pulmonary infection is a hallmark of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least... (Review)
Review
BACKGROUND
Chronic pulmonary infection is a hallmark of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least 18 closely-related species of gram-negative bacteria, are particularly difficult to treat. These infections may be associated with a fulminant necrotising pneumonia. Burkholderia cepacia complex bacteria are resistant to many common antibiotics and able to acquire resistance against many more. Following patient segregation in cystic fibrosis medical care, the more virulent epidemic strains are not as frequent, and new infections are more likely to be with less virulent environmentally-acquired strains. Although evidence-based guidelines exist for treating respiratory exacerbations involving Pseudomonas aeruginosa, these cannot be extended to Burkholderia cepacia complex infections. This review, which is an update of a previous review, aims to assess the available trial evidence for the choice and application of treatments for these infections.
OBJECTIVES
To assess the effectiveness and safety of different antibiotic regimens in people with cystic fibrosis experiencing an exacerbation and chronically infected with organisms of the Burkholderia cepacia complex.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of latest search: 28 August 2015.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials of treatments for exacerbations of pulmonary symptoms in people with cystic fibrosis chronically infected with organisms of the Burkholderia cepacia complex.
DATA COLLECTION AND ANALYSIS
No relevant trials were identified.
MAIN RESULTS
No trials were included in this review.
AUTHORS' CONCLUSIONS
Burkholderia cepacia complex infections present a significant challenge for people with cystic fibrosis and their clinicians. The incidence is likely to increase as the cystic fibrosis population ages; and managing and treating these infections will become more important. There is a lack of trial evidence to guide decision making and no conclusions can be drawn from this review about the optimal antibiotic regimens for people with cystic fibrosis who have chronic Burkholderia cepacia complex infections. Clinicians must continue to assess each person individually, taking into account in vitro antibiotic susceptibility data, previous clinical responses and their own experience. Multicentre randomised clinical trials are needed to assess the effectiveness of different antibiotic regimens in people with cystic fibrosis infected with organisms of the Burkholderia cepacia complex.
Topics: Anti-Bacterial Agents; Burkholderia Infections; Burkholderia cepacia complex; Cystic Fibrosis; Disease Progression; Humans
PubMed: 26789750
DOI: 10.1002/14651858.CD009529.pub3 -
Applied and Environmental Microbiology Apr 2015Regulations dealing with microbicides in Europe and the United States are evolving and now require data on the risk of the development of resistance in organisms...
Regulations dealing with microbicides in Europe and the United States are evolving and now require data on the risk of the development of resistance in organisms targeted by microbicidal products. There is no standard protocol to assess the risk of the development of resistance to microbicidal formulations. This study aimed to validate the use of changes in microbicide and antibiotic susceptibility as initial markers for predicting microbicide resistance and cross-resistance to antibiotics. Three industrial isolates (Pseudomonas aeruginosa, Burkholderia cepacia, and Klebsiella pneumoniae) and two Salmonella enterica serovar Typhimurium strains (SL1344 and 14028S) were exposed to a shampoo, a mouthwash, eye makeup remover, and the microbicides contained within these formulations (chlorhexidine digluconate [CHG] and benzalkonium chloride [BZC]) under realistic, in-use conditions. Baseline and postexposure data were compared. No significant increases in the MIC or the minimum bactericidal concentration (MBC) were observed for any strain after exposure to the three formulations. Increases as high as 100-fold in the MICs and MBCs of CHG and BZC for SL1344 and 14028S were observed but were unstable. Changes in antibiotic susceptibility were not clinically significant. The use of MICs and MBCs combined with antibiotic susceptibility profiling and stability testing generated reproducible data that allowed for an initial prediction of the development of resistance to microbicides. These approaches measure characteristics that are directly relevant to the concern over resistance and cross-resistance development following the use of microbicides. These are low-cost, high-throughput techniques, allowing manufacturers to provide to regulatory bodies, promptly and efficiently, data supporting an early assessment of the risk of resistance development.
Topics: Anti-Bacterial Agents; Bacteria; Benzalkonium Compounds; Burkholderia cepacia; Chlorhexidine; Cosmetics; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Microbial Sensitivity Tests; Pseudomonas aeruginosa
PubMed: 25636848
DOI: 10.1128/AEM.03843-14 -
Antimicrobial Agents and Chemotherapy Jan 2023Burkholderia cepacia complex (Bcc) and Burkholderia gladioli are opportunistic human pathogens that are inherently multidrug resistant, limiting treatment options for...
Burkholderia cepacia complex (Bcc) and Burkholderia gladioli are opportunistic human pathogens that are inherently multidrug resistant, limiting treatment options for infections. Here, a novel diazabicyclooctane, ETX0462, was evaluated for activity against Bcc and . . Ninety-eight percent of the isolates examined in this study were susceptible. ETX0462 was found to demonstrate activity superior to that of currently available treatment options (e.g., trimethoprim-sulfamethoxazole and ceftazidime).
Topics: Humans; Burkholderia; Anti-Bacterial Agents; Ceftazidime; Trimethoprim, Sulfamethoxazole Drug Combination; Burkholderia cepacia complex; Burkholderia Infections
PubMed: 36507667
DOI: 10.1128/aac.01352-22 -
Frontiers in Microbiology 2023To mine specific proteins and their protein-coding genes as suitable molecular biomarkers for the Complex (BCC) bacteria detection based on mega analysis of microbial...
OBJECTIVE
To mine specific proteins and their protein-coding genes as suitable molecular biomarkers for the Complex (BCC) bacteria detection based on mega analysis of microbial proteomic and genomic data comparisons and to develop a real-time recombinase polymerase amplification (rt-RPA) assay for rapid isothermal screening for pharmaceutical and personal care products.
METHODS
We constructed an automatic screening framework based on Python to compare the microbial proteomes of 78 BCC strains and 263 non-BCC strains to identify BCC-specific protein sequences. In addition, the specific protein-coding gene and its core DNA sequence were validated with a self-built genome database containing 158 thousand bacteria. The appropriate methodology for BCC detection using rt-RPA was evaluated by 58 strains in pure culture and 33 batches of artificially contaminated pharmaceutical and personal care products.
RESULTS
We identified the protein SecY and its protein-coding gene through the automatic comparison framework. The virtual evaluation of the conserved region of gene showed more than 99.8% specificity from the genome database, and it can distinguish all known BCC species from other bacteria by phylogenetic analysis. Furthermore, the detection limit of the rt-RPA assay targeting the gene was 5.6 × 10 CFU of BCC bacteria in pure culture or 1.2 pg of BCC bacteria genomic DNA within 30 min. It was validated to detect <1 CFU/portion of BCC bacteria from artificially contaminated samples after a pre-enrichment process. The relative trueness and sensitivity of the rt-RPA assay were 100% in practice compared to the reference methods.
CONCLUSION
The automatic comparison framework for molecular biomarker mining is straightforward, universal, applicable, and efficient. Based on recognizing the BCC-specific protein SecY and its gene, we successfully established the rt-RPA assay for rapid detection in pharmaceutical and personal care products.
PubMed: 37779692
DOI: 10.3389/fmicb.2023.1270760 -
Clinics (Sao Paulo, Brazil) Mar 2018To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation.
OBJECTIVES
To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation.
METHODS
We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013.
RESULTS
From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection.
CONCLUSION
The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.
Topics: Adolescent; Adult; Brazil; Burkholderia Infections; Burkholderia cepacia; Contraindications, Procedure; Cystic Fibrosis; DNA, Bacterial; Female; Humans; Intensive Care Units; Kaplan-Meier Estimate; Length of Stay; Lung Transplantation; Male; Phylogeny; Prospective Studies; Regression Analysis; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 29538493
DOI: 10.6061/clinics/2018/e166 -
The Pan African Medical Journal 2022Since the global pandemic of the 2019 coronavirus disease (COVID-19), few studies have reported on the relevance of bacteria co-infection on outcome of COVID-19...
Since the global pandemic of the 2019 coronavirus disease (COVID-19), few studies have reported on the relevance of bacteria co-infection on outcome of COVID-19 patients. Little is known about the clinical presentation among pregnant women, mother-to-child transmission, and fetal outcomes. This report shows a 24-year-old nulliparous woman who was 32 weeks pregnant and was admitted to the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi Ghana with symptoms of fever (40.3°C), cough and breathlessness of two weeks duration. Her nasopharyngeal sample tested positive for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and blood culture isolated Burkholderia cepacia. She was given medications but went into pre-term labour and delivered a stillborn baby. This rare case of COVID-19 and Burkholderia cepacia co-infection emphasizes the need for a thorough assessment and appropriate treatment of patients presenting with fever and respiratory symptoms in order to mitigate poor outcome.
Topics: Adult; Burkholderia cepacia; COVID-19; Coinfection; Female; Fetal Death; Fever; Humans; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; SARS-CoV-2; Young Adult
PubMed: 36187044
DOI: 10.11604/pamj.2022.42.173.33813 -
Infectious Diseases & Clinical... Sep 2023We aimed to define the clinical features and antimicrobial susceptibility profiles of complex infections and to determine the predictors for mortality.
OBJECTIVE
We aimed to define the clinical features and antimicrobial susceptibility profiles of complex infections and to determine the predictors for mortality.
MATERIALS AND METHODS
Our single-center retrospective study included patients with nosocomial complex infection between 2018 and 2022. We evaluated the predictors of 14-day and 28-day mortality by analyzing clinical and microbiological data.
RESULTS
A total of 87 patients were included. Most infections (79.3%) occurred in the intensive care units (ICUs). Among complex isolates, 74.7% were susceptible to trimethoprim-sulfamethoxazole, 70.3% to levofloxacin, 50% to meropenem, and 23.4% to ceftazidime. The rates of 14-day mortality, 28-day mortality, and in-hospital mortality were 41.3% (n=36), 52.8% (n=46), and 64.3% (n=56), respectively. Multivariate analysis revealed neutrophil/lymphocyte ratio (NLR) (odds ratio [OR]=1.05, =0.024), platelet count (OR=1.00, =0.011), creatinine (OR=2.14, =0.006), and aspartate aminotransferase (AST) (OR=1.02, =0.028) as predictors for 14-day mortality. In addition to NLR (OR=1.07, =0.014), platelet count (OR=1.00, =0.039), creatinine (OR=2.05, =0.008), and AST (OR=1.02, =0.035), procalcitonin (OR=1.05, =0.049) was also found as an independent predictor for 28-day mortality. In receiver operating characteristic (ROC) curve analysis for predicting 14-day mortality, area under the ROC curve (AUC) values were 0.684 (=0.003) in NLR, 0.719 (<0.001) in platelet count, 0.673 (=0.003) in procalcitonin, 0.743 (<0.001) in creatinine, and 0.700 (<0.001) in AST. In ROC curve analysis for predicting 28-day mortality, AUC values were 0.674 (=0.002) in NLR, 0.651 (=0.010) in platelet count, 0.638 (=0.020) in procalcitonin, 0.730 (<0.001) in creatinine, and 0.692 (=0.001) in AST.
CONCLUSION
Increasing antibiotic resistance and higher mortality rates justify that complex is a significant threat to hospitalized patients, especially in ICUs. Elevated levels of NLR, AST, creatinine, procalcitonin, and decreased platelet may predict poor clinical outcomes and could help clinicians in the management of this notorious bacterial pathogen.
PubMed: 38633558
DOI: 10.36519/idcm.2023.259 -
American Journal of Kidney Diseases :... Jun 2017Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis...
BACKGROUND
Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis centers that reprocessed dialyzers for reuse on patients. We investigated an outbreak of bloodstream infections caused by B cepacia and S maltophilia among hemodialysis patients in clinics of a dialysis organization.
STUDY DESIGN
Outbreak investigation, including matched case-control study.
SETTING & PARTICIPANTS
Hemodialysis patients treated in multiple outpatient clinics owned by a dialysis organization.
PREDICTORS
Main predictors were dialyzer reuse, dialyzer model, and dialyzer reprocessing practice.
OUTCOMES
Case patients had a bloodstream infection caused by B cepacia or S maltophilia; controls were patients without infection dialyzed at the same clinic on the same day as a case; results of environmental cultures and organism typing.
RESULTS
17 cases (9 B cepacia and 8 S maltophilia bloodstream infections) occurred in 5 clinics owned by the same dialysis organization. Case patients were more likely to have received hemodialysis with a dialyzer that had been used more than 6 times (matched OR, 7.03; 95% CI, 1.38-69.76) and to have been dialyzed with a specific reusable dialyzer (Model R) with sealed ends (OR, 22.87; 95% CI, 4.49-∞). No major lapses during dialyzer reprocessing were identified that could explain the outbreak. B cepacia was isolated from samples collected from a dialyzer header-cleaning machine from a clinic with cases and was indistinguishable from a patient isolate collected from the same clinic, by pulsed-field gel electrophoresis. Gram-negative bacteria were isolated from 2 reused Model R dialyzers that had undergone the facility's reprocessing procedure.
LIMITATIONS
Limited statistical power and overmatching; few patient isolates and dialyzers available for testing.
CONCLUSIONS
This outbreak was likely caused by contamination during reprocessing of reused dialyzers. Results of this and previous investigations demonstrate that exposing patients to reused dialyzers increases the risk for bloodstream infections. To reduce infection risk, providers should consider implementing single dialyzer use whenever possible.
Topics: Aged; Aged, 80 and over; Bacteremia; Burkholderia Infections; Burkholderia cepacia; Case-Control Studies; Decontamination; Disease Outbreaks; Disinfection; Equipment Contamination; Female; Gram-Negative Bacterial Infections; Humans; Infection Control; Kidney Failure, Chronic; Kidneys, Artificial; Male; Middle Aged; Renal Dialysis; Stenotrophomonas maltophilia; United States
PubMed: 27940061
DOI: 10.1053/j.ajkd.2016.09.022