c Cepacia syndrome (CS) is a fatal septic condition that develops in approximately 20% of cystic fibrosis (CF) patients chronically infected with the Burkholderia cepacia complex (Bcc). The most common causative agent is Burkholderia cenocepacia, a clinically dominant Bcc species that contains the globally distributed epidemic strain sequence type 32 (ST32). Using microarrays, we compared the transcriptomes of ST32 isolates from the bloodstream at the time of CS with their sputum counterparts recovered 1 to 2 months prior to the development of CS. Global gene expression profiles of blood isolates revealed greater activities of the virulence genes involved in the type III secretion system, the bacterial exopolysaccharide cepacian, and quorum sensing, while reduced expression was demonstrated for flagellar genes. Furthermore, a nonmotile phenotype (as evaluated by a swimming motility assay) was identified in blood isolates from 6 out of 8 patients with CS; this phenotype was traceable to 24 months prior to the onset of CS. Loss of motility was not observed in any of the 89 ST32 isolates recovered over the course of chronic infection from 17 patients without CS. In conclusion, the gene expression of Bcc bacteria disseminated during CS has been elucidated for the first time. This study demonstrated marked differences at the transcriptome level between isogenic ST32 isolates that are attributable to the stage and site of infection. The finding of a nonmotile B. cenocepacia isolate may serve as a warning sign for the development of CS in the near future. P atients with cystic fibrosis (CF) spend a lifetime at risk of contracting bacteria from the Burkholderia cepacia complex (Bcc), consisting of a group of 18 genetically closely related bacterial species (1). These microorganisms usually cause chronic respiratory infections in CF patients and result in little chance of treatment success due to their intrinsic resistance to most antimicrobials (2). Moreover, they pose a high risk for the development of a fatal clinical condition termed cepacia syndrome (CS). Because of this unfavorable outcome, Bcc species are considered particularly troublesome CF pathogens associated with not only increased morbidity but also increased mortality (3). Additionally, they spread relatively easily among CF patients and have resulted in several serious Bcc outbreaks in the past. A multicenter outbreak was reported for epidemic lineage ET12 (4), while in a local epidemic identified at the Prague CF Centre in the early 2000s, 30% of the CF population was found to be infected with a single Bcc strain. This strain was designated by multilocus sequence typing (MLST) (5) as sequence type 32 (ST32).Cepacia syndrome (CS) is a worrying terminal phase of Bcc infection characterized by pulmonary exacerbation, high levels of inflammatory markers, new multifocal lung infiltrates visible by chest X-ray, and a positive blood culture for Bcc bacteria. CS is linked mostly to Burkholderia cenocepacia, a species that is clinically dominant among the Bcc mem...