Misidentification of Burkholderia pseudomallei as Burkholderia cepacia by the VITEK 2 system

Zong, Zhiyong; Wang, Xiaohui; Deng, Yiyun; Zhou, Taoyou

doi:10.1099/jmm.0.041525-0

Cited by 45 publications

(31 citation statements)

References 13 publications

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“…Moreover, B. thailandensis has been misidentified as B. pseudomallei by the API 20NE (35). Although, in our case, the automated Vitek 2 system at the outside hospital laboratory correctly identified the isolate as B. pseudomallei, the automated Vitek 2 system with a newer-generation identification card has been reported to perform variably, with an accuracy of between 63% and 81% (8), and to misidentify B. pseudomallei as B. cepacia (8). The Phoenix and MicroScan WalkAway 96 systems have reportedly performed poorly in the identification of B. pseudomallei (8).…”

Section: Laboratory Diagnosis and Rule-out Guidelinesmentioning

confidence: 72%

“…Although, in our case, the automated Vitek 2 system at the outside hospital laboratory correctly identified the isolate as B. pseudomallei, the automated Vitek 2 system with a newer-generation identification card has been reported to perform variably, with an accuracy of between 63% and 81% (8), and to misidentify B. pseudomallei as B. cepacia (8). The Phoenix and MicroScan WalkAway 96 systems have reportedly performed poorly in the identification of B. pseudomallei (8). With these potential identification errors, it is not advisable for a clinical laboratory to use any of these systems to rule out an isolate as B. pseudomallei.…”

Section: Laboratory Diagnosis and Rule-out Guidelinesmentioning

confidence: 95%

“…Identification of B. pseudomallei and all occupational exposures must be reported to the Federal Select Agent Program within 24 h (7). As demonstrated in this case, B. pseudomallei appears similar in culture to many other non-glucose-fermenting Gram-negative rods, and identification of the bacterium using commercially available automated systems is unreliable (8). This minireview focuses on the laboratory challenges involved in dealing with B. pseudomallei or clinical specimens from suspected melioidosis cases.…”

Section: Introductionmentioning

confidence: 99%

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Burkholderia pseudomallei: Challenges for the Clinical Microbiology Laboratory

et al. 2016

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bMelioidosis is a potentially fatal infection caused by the bacterium Burkholderia pseudomallei. Clinical diagnosis of melioidosis can be challenging since there is no pathognomonic clinical syndrome, and the organism is often misidentified by methods used routinely in clinical laboratories. Although the disease is more prevalent in Thailand and northern Australia, sporadic cases may be encountered in areas where it is not endemic, including the United States. Since the organism is considered a tier 1 select agent according to the Centers for Disease Control and Prevention and the U.S. Department of Agriculture Animal and Plant Health Inspection Service, clinical laboratories must be proficient at rapidly recognizing isolates suspicious for B. pseudomallei, be able to safely perform necessary rule-out tests, and to refer suspect isolates to Laboratory Response Network reference laboratories. In this minireview, we report a case of melioidosis encountered at our institution and discuss the laboratory challenges encountered when dealing with clinical isolates suspicious for B. pseudomallei or clinical specimens from suspected melioidosis cases. CASEA 67-year-old Filipino woman with a previous history of treated tuberculosis, hypertension, type 2 diabetes, coronary artery disease, and complete heart block requiring a pacemaker and drug-eluting stent that was placed 4 months earlier presented to an outside hospital with 2 weeks of progressive left lower quadrant abdominal pain, chills, and subjective fever. She was evaluated in different emergency departments for similar complaints on two occasions in the preceding week, but was discharged home. She was admitted to an outside hospital on this visit and computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed an 8 by 8 by 8 mm suprarenal saccular aneurysm arising from the posterior aortic wall with surrounding inflammation. Blood cultures drawn in the emergency department grew a Gram-negative rod, which was identified by the Vitek 2 (bioMérieux, Durham NC) as Burkholderia pseudomallei. This identification was confirmed several weeks later by the Centers for Disease Control and Prevention (CDC). Transthoracic echocardiography showed no vegetation. The patient was treated with meropenem 1 g intravenously (i.v.) every 8 hours (q8h). Follow-up CT scans performed 9 days after presentation showed that the mycotic aneurysm had enlarged to 13 by 24 by 20 mm and revealed a second aneurysm of the lateral wall of the aorta measuring 4 by 4 mm.The patient was transferred to our institution for surgical evaluation. On arrival, two sets of blood cultures (BD Bactec FX system; Becton, Dickinson and Company, NJ) were collected. Within 48 h of transfer, the patient underwent surgical excision of the mycotic aneurysm and reconstruction of her aorta using bioprosthetic homografts. During the procedure, the aneurysm was found to have ruptured, with the resulting pseudoaneurysm encased in inflammatory material and purulent fluid. Intraoperative samples from t...

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Section: Laboratory Diagnosis and Rule-out Guidelinesmentioning

confidence: 72%

Section: Laboratory Diagnosis and Rule-out Guidelinesmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Burkholderia pseudomallei: Challenges for the Clinical Microbiology Laboratory

et al. 2016

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“…Thirty-seven (84%) isolates were ST881, with this ST forming the majority of samples from hospitals in the central region of Sarawak (i.e., Bintulu, Kapit, and Sibu). ST881 has been reported once previously, in a Chinese traveler returning from working in the Malaysian jungle (22). The sole isolate from the Miri hospital in northern Sarawak was ST271.…”

Section: Resultsmentioning

confidence: 96%

Burkholderia pseudomallei Isolates from Sarawak, Malaysian Borneo, Are Predominantly Susceptible to Aminoglycosides and Macrolides

Podin

Sarovich

Price

et al. 2014

Antimicrob Agents Chemother

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h Melioidosis is a potentially fatal disease caused by the saprophytic bacterium Burkholderia pseudomallei. Resistance to gentamicin is generally a hallmark of B. pseudomallei, and gentamicin is a selective agent in media used for diagnosis of melioidosis. In this study, we determined the prevalence and mechanism of gentamicin susceptibility found in B. pseudomallei isolates from Sarawak, Malaysian Borneo. We performed multilocus sequence typing and antibiotic susceptibility testing on 44 B. pseudomallei clinical isolates from melioidosis patients in Sarawak district hospitals. Whole-genome sequencing was used to identify the mechanism of gentamicin susceptibility. A novel allelic-specific PCR was designed to differentiate gentamicin-sensitive isolates from wild-type B. pseudomallei. A reversion assay was performed to confirm the involvement of this mechanism in gentamicin susceptibility. A substantial proportion (86%) of B. pseudomallei clinical isolates in Sarawak, Malaysian Borneo, were found to be susceptible to the aminoglycoside gentamicin, a rare occurrence in other regions where B. pseudomallei is endemic. Gentamicin sensitivity was restricted to genetically related strains belonging to sequence type 881 or its single-locus variant, sequence type 997. Whole-genome sequencing identified a novel nonsynonymous mutation within amrB, encoding an essential component of the AmrAB-OprA multidrug efflux pump. We confirmed the role of this mutation in conferring aminoglycoside and macrolide sensitivity by reversion of this mutation to the wild-type sequence. Our study demonstrates that alternative B. pseudomallei selective media without gentamicin are needed for accurate melioidosis laboratory diagnosis in Sarawak. This finding may also have implications for environmental sampling of other locations to test for B. pseudomallei endemicity.

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“…A particular problem has been the misidentification of B. pseudomallei as Burkholderia cepacia by the Vitek 2 automated biochemical system (bioMérieux) (5)(6)(7)(8). B. cepacia belongs to a group of 17 phenotypically and genotypically similar species which form the B. cepacia complex, with B. cepacia specifically noted as an opportunistic pathogen infecting and causing progressive pulmonary deterioration in patients with cystic fibrosis (14,15).…”

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confidence: 99%

Reliability of Automated Biochemical Identification of Burkholderia pseudomallei Is Regionally Dependent

et al. 2013

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Misidentifications of Burkholderia pseudomallei as Burkholderia cepacia by Vitek 2 have occurred. Multidimensional scaling ordination of biochemical profiles of 217 Malaysian and Australian B. pseudomallei isolates found clustering of misidentified B. pseudomallei isolates from Malaysian Borneo. Specificity of B. pseudomallei identification in Vitek 2 and potentially other automated identification systems is regionally dependent.

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Misidentification of Burkholderia pseudomallei as Burkholderia cepacia by the VITEK 2 system

Cited by 45 publications

References 13 publications

Burkholderia pseudomallei: Challenges for the Clinical Microbiology Laboratory

Burkholderia pseudomallei: Challenges for the Clinical Microbiology Laboratory

Burkholderia pseudomallei Isolates from Sarawak, Malaysian Borneo, Are Predominantly Susceptible to Aminoglycosides and Macrolides

Reliability of Automated Biochemical Identification of Burkholderia pseudomallei Is Regionally Dependent

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