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

Abstract

During March 2016–January 2019, Burkholderia cepacia complex (BCC) infection developed in 13 persons who inject drugs (PWID) in Kowloon West Region, Hong Kong, China. Seven cases were infective spondylitis, 2 endocarditis, 2 septic arthritis, 1 intramuscular abscess and bacteremia, and 1 necrotizing fasciitis. Pulsed-field gel electrophoresis revealed that the isolates from 9 patients were clonally related. This clone caused major illness, and 11 of the 13 patients required surgical treatment. Clinicians should be aware of this pathogen and the appropriate broad-spectrum antimicrobial drugs to empirically prescribe for PWID with this life-threatening infection. Close collaboration among public health authorities, outreach social workers, and methadone clinics is essential for timely prevention and control of outbreaks in the PWID population.

Showing the limitations of available phenotypic assays to detect Burkholderia pseudomallei from clinical specimens in Nigeria

“…Nonetheless, the bulk of our isolates were recognized as B. cepacia, a well-known Bcc member. Given the fact that the global burden of Bcc infections is unknown, members of the group have been documented to infect immunocompromised individuals and drug users [22,34].…”

“…The distinctive purple colour and dry and wrinkled texture of B. pseudomallei colonies can be used to provide a preliminary diagnosis [22]. Suspected Burkholderia isolates were subcultured on tryptic soy agar (Himedia) for purity.…”

“…All isolates were then subcultured on Ashdown’s agar and the plates were incubated at 37 °C for 24–48 h. The colony appearance on Ashdown’s media was noted. The distinctive purple colour and dry and wrinkled texture of B. pseudomallei colonies can be used to provide a preliminary diagnosis [ 22 ]. Suspected Burkholderia isolates were subcultured on tryptic soy agar (Himedia) for purity.…”

Assessment of Bacterial Infections and Antibiotic Regimens in Intravenous Drug Users

“…This is formidable in view of public health as hospitalizations for infections related to IDU are distinguished by a prolonged stay at the hospital as well as frequent readmission rates, higher patient-directed discharge, and increased intermediate to long-term mortality leading to significant expense to the healthcare system [ 8 ][ 9 ]. Furthermore, the increased need for antibiotics in PWID contributes to the development of multidrug-resistant bacteria and MRSA colonization [ 6 , 11 , 15 ]. Infected PWIDs can eventually introduce drug-resistant strains to the general public or immunocompromised individuals [ 11 ].…”

“…In PWID, S. aureus is one of the most common organisms causing superficial skin infections, communityacquired pneumonia, infective endocarditis, osteomyelitis, septic arthritis, and bacteremia [13][14][15][16][17][18]. However, many of these conditions seen in PWID also have concomitant identification of other prominent bacteria.…”