Objectives The 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 methods This 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. Results The 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. Conclusions Bcc 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.

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Background Burkholderia cenocepacia has been described to cause mainly respiratory tract infections. We noticed an increased number of skin and soft tissue infections (SSTIs), bloodstream infections (BSIs) and osteomyelitis over the past years at our medical center. Methods This is a retrospective chart review of 44 patients with documented B. cenocepacia infection at sites other than the respiratory tract diagnosed between 2005 and 2020 at the American University of Beirut Medical Center, a tertiary referral hospital for the Middle East region. Results The nationalities of our patients were Iraqi (40.9%), Lebanese (34.1%), and Syrian (20.5%). Twenty six of the infections (59.1%) were hospital-acquired infections (HAIs). The most common infections were BSIs (17/44, 38.6%), then SSTIs as well as deep seated cysts and abscesses (16/44, 36.4%) and vertebral osteomyelitis (8/44, 18.2%). Half of the vertebral osteomyelitis were located in the lumbar, and 3 in the cervical region; 5 of these cases were native osteomyelitis. Sixteen patients (36.4%) had prior antibiotic intake within 30 days with ceftazidime, carbapenems and quinolones being the most common. All the patients received directed therapy for an average duration of 23.48 (+/- 37.779) days, and for 60 days for those with osteomyelitis. Combination regimens of 2 antibiotics (ceftazidime, quinolones, carbapenems, trimethoprim-sulfamethoxazole (TMP-SMX)) were used in 10 patients, whereas 24 received a single antibiotic. Thirty three patients (75%) were admitted to the hospital, 20 (45.5%) of which had an indwelling catheter and 12 (27.3%) were in the intensive care unit. Thirty two patients (96.9%) were discharged home. Susceptibility testing revealed 84.1%, 54.5%, 63.2%, and 65.9% susceptibility to ceftazidime, tetracycline, TMP-SMX, and carbapenems respectively. Characteristics of patients Conclusion B. cenocepacia BSIs, SSTIs, abscesses, and osteomyelitis were noted to be more common at our medical center as HAIs particularly in Iraqi and Syrian patients, raising the concern that countries at war might be at increased risk for such infections. Our susceptibilities results were consistent with the literature. Although B. cenocepacia is a resistant bacteria, the majority of our patients were successfully treated. Disclosures All Authors: No reported disclosures