Clinical and microbiological profile of chronic Burkholderia cepacia complex infections in a cystic fibrosis reference hospital in Brazil

Abstract

Burkholderia sp. infections are extremely complex in cystic fibrosis (CF) patients, especially considering the lack of knowledge regarding its behavior, its relationship with prognosis, as well as its transmissibility and multidrug resistance features. This study evaluated the frequency of chronic infection by Burkholderia, using microbiological and clinical data. Ninety-eight patients with CF attended from July 2011 to April 2014 in a Brazilian reference hospital were included. Antimicrobial activity, molecular epidemiology, Shwachman score, body mass index, exacerbations, and lung function were analyzed. Nine patients had chronic colonization, and all of them showed preserved pulmonary function levels, body mass index, and Shwachman score. Meropenem was the most effective antibiotic; however, divergent results were shown by other studies. Cross-contamination may have occurred in only two unrelated patients of different ages, who were colonized by B. vietnamiensis, which does not occur frequently. Twelve new sequence types (STs) were identified and three STs have presented intercontinental distribution. None of the patients presented known epidemic strains. In conclusion, a relatively low number of patients with chronic colonization and suspected cross-infection were identified. Different from other studies that have found CF patients chronically colonized with Burkholderia sp. having a greater deterioration of lung function, more frequent antibiotic therapy, and increased mortality, in the current study, the patients showed good clinical outcomes and favorable options for antibiotics therapy. This study also updated the epidemiological database, which facilitates the multicentric collaborative analysis and assists in the control of global infection by these pathogens.

The Lung Microbiome of Three Young Brazilian Patients With Cystic Fibrosis Colonized by Fungi

“…These members are most frequently isolated from patients with CF and generally linked to pulmonary deterioration (Coburn et al, 2015), high risk to the host due to multidrug resistance, easy transmissibility, the potential to cause septicemia, and an unpredictable clinical outcome, varying from an asymptomatic infection up to fatal pneumonia known as "cepacia syndrome" (Zlosnik et al, 2015;Hector et al, 2016). A previous study in the same hospital showed patients with good clinical outcomes and favorable options for antibiotic therapy (da Costa Capizzani et al, 2017). Even so, possibly the highly impaired lung functions of these young patients are related to the early presence of very pathogenic bacteria, related to adverse outcomes.…”