Burkholderia cepacia Infections at Sites Other than the Respiratory Tract: A Large Case Series from a Tertiary Referral Hospital in Lebanon

Abstract

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.

Prevalence of Burkholderia cepacia recovered from clinical specimens in the Zainoel Abidin general hospital, Banda Aceh, Indonesia

“…Most of these bacteria isolated from blood cultures come from patients who have a background of end stage renal disease. This is in accordance with previous study demonstrated that B. cepacia were the most commonly found in blood specimens accounting for which was associated with bloodstream infections ( 15 , 16 ). Moreover, other investigators highlighted the prevalence of B. cepacia detected in 30 patients with bloodstream infections during two-year period ( 17 ) indicating B. cepacia as emerging pathogens in blood stream infections.…”

“…In this investigation, men were more likely to be infected with B. cepacia than women. This is consistent with previous research showing that men are more susceptible to these infections than women ( 14 , 15 , 21 ). It is believed that this may be due to the role of genetic and hormonal factors, i.e.…”

Hospital-acquired pneumonia due to Burkholderia cepacia in a thalassemia pregnancy with postoperative eclampsia: A case report

“…BCC is primarily recognized for the ability to cause infections in individuals with cystic fibrosis [ 1 , 4 , 11 ], chronic granulomatous disease [ 11 ], and compromised immune systems [ 1 ]. There are increasing reports of BCC infections among patients without cystic fibrosis [ 12 , 13 ] or presenting with clinical symptoms beyond the respiratory system [ 14 ]. However, characteristics such as pregnancy, thalassemia, and eclampsia have not been reported in association with BCC infections.…”

Burkholderia cepacia Complex Infections in Urgently Referred Neonates from Syrian Border Regions to a Hospital in Turkey: A Cross-Border Cluster

“…B. cepacia was identified as the most common cause of early neonatal sepsis in Yemen [ 7 ]. A study conducted in a tertiary hospital in Lebanon reported that BCC infections were more common in refugees [ 8 ]. These findings raise the concern that countries at war might be at increased risk for such infections.…”

“…In neonates, BCC infections are usually reported as outbreaks in the neonatal intensive care unit (NICU). In addition to nosocomial infections, very few studies in the literature show that BCC is an important infectious agent group that can also cause community-acquired infections in areas with limited access to healthcare [ 7 , 8 ]. In this study, neonates referred to a NICU in Turkey from different centers, including the cross-border regions of Syria, shortly after birth and who were diagnosed with BCC bacteremia at admission were examined.…”