Clinical andin vitroevidence for the antimicrobial therapy inBurkholderia cepaciacomplex infections

Abstract

Treatment of infections caused by Burkholderia cepacia complex (Bcc) in cystic fibrosis (CF) patients poses a complex problem. Bcc is multidrug-resistant due to innate and acquired mechanisms of resistance. As CF patients receive multiple courses of antibiotics, susceptibility patterns of strains from CF patients may differ from those noted in strains from non-CF patients. Thus, there was a need for assessing in vitro and clinical data to guide antimicrobial therapy in these patients. A systematic search of literature, followed by extraction and analysis of available information from human and in vitro studies was done. The results of the analysis are used to address various aspects like use of antimicrobials for pulmonary and non-pulmonary infections, use of combination versus monotherapy, early eradication, duration of therapy, route of administration, management of biofilms, development of resistance during therapy, pharmacokinetics-pharmacodynamics correlations, therapy in post-transplant patients and newer drugs in Bcc-infected CF patients.

An Overview of the Treatment of Less Common Non–Lactose‐Fermenting Gram‐Negative Bacteria

“…For example, researchers published a case series of 19 cystic fibrosis patients with BCC; the organism was eradicated in seven patients, three of whom did not receive any therapy. 34 The other four patients received different regimens consisting of combinations of minocycline, trimethoprim-sulfamethoxazole, meropenem, aztreonam, ciprofloxacin, piperacillin-tazobactam, and nebulized tobramycin. 34 A case report of persistent BCC bacteremia in a 2-month-old infant was cleared with ceftazidime-avibactam.…”

“…34 The other four patients received different regimens consisting of combinations of minocycline, trimethoprim-sulfamethoxazole, meropenem, aztreonam, ciprofloxacin, piperacillin-tazobactam, and nebulized tobramycin. 34 A case report of persistent BCC bacteremia in a 2-month-old infant was cleared with ceftazidime-avibactam. 35 Due to limited in vivo evidence, treatment of BCC is largely driven by in vitro data and individual susceptibilities.…”

Burkholderia cenocepacia Infections in Cystic Fibrosis Patients: Drug Resistance and Therapeutic Approaches

“…Until now, no standard treatment strategy has been described to eradicate B. cenocepacia chronic infections ( Horsley and Jones, 2012 ; Regan and Bhatt, 2016 ). Several questions remain unanswered: the lack of correlation between in vitro and in vivo susceptibility data, the duration of therapy, the use of mono vs. combined antibiotic therapy ( Gautam et al, 2015 ).…”

In vitro activity of N-acetylcysteine against Stenotrophomonas maltophilia and Burkholderia cepacia complex grown in planktonic phase and biofilm

“…In order to find new drugs and combinations to improve the outcome of chronic lung colonization by S . maltophilia and Bcc in CF patients, a renewed interest has been recently focused on inhaled route of administration, which allow to achieve higher drug concentrations in the lungs, whilst limiting systemic toxicity [ 16 , 17 ].…”