Management of initial colonisations with Burkholderia species in France, a retrospective analysis in five Cystic Fibrosis Centres

Abstract

Whereas Burkholderia infections are recognized to impair prognosis in cystic fibrosis (CF) patients, there is no recommendation to date for early eradication therapy. The aim of our study was to analyse the current management of initial colonisations with Burkholderia cepacia complex (BCC) or B. gladioli in French CF Centres and its impact on bacterial clearance and clinical outcome. We performed a retrospective review of the primary colonisations (PC) observed between 2010 and 2018 in five CF Centres. Treatment regimens, microbiological and clinical data were collected. Seventeen patients (14 with BCC, and 3 with B. gladioli) were included. Eradication therapy, using heterogeneous combinations of intravenous, oral or nebulised antibiotics, was attempted in 11 patients. Six out of the 11 treated patients, and 4 out of the 6 untreated patients cleared the bacterium. Though not statistically significant, higher FEV1 and FVC at PC and consistency of treatment with in vitro antibiotic susceptibility tended to be associated with eradication. Thus, the management of PC was shown to be heterogeneous, and the statistic power of our study insufficient. Large prospective studies are needed to define who to treat, when, and how. Pending these studies, we propose, due to possible spontaneous clearance, to check the presence of Burkholderia one month after PC before starting antibiotics, at least in the milder cases, and to evaluate a combination of IV beta-lactam + oral or IV fluoroquinolone + inhaled aminoglycoside.

Genomic and phenotypic characterization of Burkholderia isolates from the potable water system of the International Space Station

“…B. contaminans, however, can be distinguished by their yellow pigmentation and hemolytic quality [13]. CF infections with this species is the most prevalent in Spain, Portugal and the Ibero-American countries, whereas B. cepacia infections are more prevalent in the Iberian Peninsula alone [14]. The genomes of BCC organisms can mutate rapidly during infections or when subjected to high-stress conditions [15], the latter of which might be satisfied by the sequential iodine treatments of the PWD.…”