Burkholderia cepacia complex

Background

• Gram-negative bacillus
• Classified into nine genomovars (phenotypically similar but genotypically distinct)
  • Burkholderia cenocepacia (genomovar III)
  • Burkholderia multivorans (genomovar II)
  • Burkholderia dolosa (genomovar VI)
• Environmental organism
• Multiple mechanisms of resistance:
  • β-lactamases
  • RND efflux pumps
  • Altered LPS conferring polymixin resistance
  • Gyrase mutations conferring fluoroquinolone resistance

Clinical Manifestations

• Opportunistic lung infections, primarily of cystic fibrosis and lung transplant patients
• Colonizes the lungs of patients with cystic fibrosis and portends a poor prognosis
• Occasionally causes nosocomial outbreaks traced back to aqueous pharmaceutical products
• Also causes hospital- or ventilator-associated pneumonia, bacteremia (possibly CLABSI), ecthyma gangrenosum, burn infection, wound infection, endophthalmitis, and rarely endocarditis

Management

• Should be guided by antimicrobial susceptibility testing
• Antibiotic options include:
  • TMP-SMX (preferred, if susceptible)
  • Ceftazidime 2 g IV q8h and ceftazidime-avibactam 2.5 g IV q8h
  • Meropenem 1-2 g IV q8h and imipenem 1 g IV q8h
  • Minocycline 100 mg p.o.IV q12h