Burkholderia cepacia complexCervical Osteomyelitis in an Intravenous Drug User

Abstract

Gram-negative vertebral osteomyelitis infections are increasing due to rising intravenous drug use but overall remain uncommon. Here, we present a case of Burkholderia cepacia complex cervical osteomyelitis in an intravenous drug user. Burkholderia cepaciacomplex vertebral osteomyelitis has been infrequently described in the literature thus far with varied antibiotic treatment regimens. A 68-year-old male presented to the emergency department with neck pain after minor trauma. He endorsed active intravenous heroin and methamphetamine use. CT and MRI imaging of the cervical spine revealed destructive changes of C5-C6 vertebral bodies consistent with osteomyelitis. Neurological exam was stable and vital signs were within normal limits; so, antibiotics were held, and he was admitted for diagnostic evaluation. Five sets of blood cultures were drawn on admission and were ultimately negative. He subsequently underwent C5-C6 corpectomy, C4-C7 anterior fusion, and C3-T1 posterior fusion with allograft placement. Deep operative tissue cultures grew Burkholderia cepacia complex. He was treated with 6 weeks of intravenous ceftazidime followed by indefinite oral minocycline due to hardware placement. Burkholderia cepacia complex should be considered among pathogenic etiologies of pyogenic vertebral osteomyelitis, particularly among patients with intravenous drug use. Ceftazidime monotherapy was an effective treatment in this particular case.

Burkholderia cepacia Complex Lumbar Spondylodiscitis: A Rare Nosocomial Infection

“…This case is also remarkable because B. cepacia rarely causes osteomyelitis and discitis. Most cases are related to spinal surgery, trauma, intravenous drug use, or postoperative complications [ 4 , 12 – 16 ]. One case-control study of non-CF patients found recent abdominal surgery to be an independent risk factor for Burkholderia cepacia bacteremia [ 17 ].…”

Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016–2019

“…Most frequently involved was the lumbar area (5 patients), followed by the thoracic (1 patient) and cervical (1 patient) areas. BCC spondylodiscitis is a rare entity; the medical literature has reported only 6 cases, 3 of which were in patients with the risk factor of being PWID ( 11 , 25 , 26 ). Pyogenic osteomyelitis after rhinoplasty has also been described; other affected persons were a healthy elderly farmer and a patient after a fall and intramuscular procedure ( 33 – 35 ).…”

“…Last, whole-genome sequencing is not readily available in our laboratory, and the resolution of PFGE may not be enough for a large-scale outbreak. Nevertheless, there is no well-established cutoff for the number of single-nucleotide polymorphisms of BCC to be classified as a cluster, and it could be quite variable ( 26 ). PFGE consists of genomic information that was considered to provide sufficient information for evaluating this focused outbreak ( 46 – 49 ).…”