Molecular and epidemiological analysis of a Burkholderia cepacia sepsis outbreak from a tertiary care hospital in Bangladesh

Abstract

Background Burkholderia cepacia complex (Bcc) is a group of serious pathogens in cystic fibrosis patients and causes life threatening infections in immunocompromised patients. Species within the Bcc are widely distributed within the environment, can survive in the presence of disinfectants and antiseptics, and are inherently multidrug resistant (MDR). Methods Dhaka Medical College Hospital (DMCH) patients with a B. cepacia positive blood culture between 20 October 2016 to 23 rd September 2017 were considered as outbreak cases. Blood stream infections (BSIs) were detected using BacT/ALERT 3D at DMCH. B. cepacia was isolated on chromogenic UTI media followed by MALDI-TOF. Minimum inhibitory concentration (MIC) of clinically relevant antibiotics was determined by agar dilution. Whole genome sequencing was performed on an Illumina MiSeq platform. Patients' demographic and clinical data were collected. Patients' clinical history and genomic data of the outbreak strains were merged to investigate possible outbreaks. Ninety-one B. cepacia genomes were downloaded from 'Burkholderia Genome Database' and the genomic background of the global strains were compared with our outbreak strains. Results Among 236 BSIs, 6.35% (15/236) were B. cepacia. Outbreak cases were confined to the burn critical care unit and, to a lesser extent, the paediatrics department. There was a continuum of overlapping cases at DMCH between 23 October 2016 to 30 August 2017. Core genome SNPs showed that the outbreak strains were confined to a single clade, corresponded to a common clone (ST1578). The strains were shown to be MDR and associated with a mortality of 31% excluding discharge against medical advice. MIC profiles of the PLOS NEGLECTED TROPICAL DISEASES

Burkholderia Cepacia: An Emerging Superbug in Intensive Care Unit Settings of Tertiary Care Hospitals in Pakistan

“…17 Another study in Bangladesh showed 100% sensitivity to Meropenem, and 93% of isolates were resistant or intermediate to levofloxacin. 19 The results from SENTRY Antimicrobial surveillance program showed greater than 90% susceptibility to Minocycline, similar to our results in which Minocycline is considered the most effective antibiotic. 20 However, the current clinical information is not adequate, and further studies are necessary to determine the in vitro efficacy of these antimicrobial agents for Burkholderia cepacia infections.…”

Patogenesis dan virulensi Burkholderia pseudomallei penyebab melioidosis dan Burkholderia cepacia sebagai patogen oportunis

“…(19) Mikroorganisme ini menyebabkan tiga masalah penting pada kelompok penderita CF, yaitu multi resisten terhadap agen antimikrobia, transmisi antar manusia (secara nosokomial ataupun nonnosokomial) serta menyebabkan sindrom cepacia. (20,21) Sindrom cepacia merupakan pneumonia yang sering diasosiasikan dengan septikemia. (21) Genus Burkholderia terdiri lebih dari 60 spesies.…”

“…Kemampuan resistensi antibiotik ini terbukti dengan ditemukannya enzim betalactamase, efflux systems pada bakteri ini serta kemampuan bakteri ini hidup di lingkungan intraselular. (20,32) Bcc termasuk dalam kelompok bakteri Multi Drug Resistance (MDR). Berbagai mekanisme reesistensi pada Bcc diantaranya adalah inaktifasi enzimatik, pengubahan target obat, impermeabilitas dinding sel dan efflux pump.…”

“…Dinyatakan juga bahwa efflux-system dapat membantu pertumbuhan dan pembentukan biofilm pada kelompok Bcc. (20,31,32)…”

A Molecular Study with A Comparison of the Odds of Diagnostic Methods For Burkholderia Cepacia Bacteria Isolated from Patients with Diabetic Foot Ulcer

“…In 2002, Genomover III, which contains some of the more infectious strains of B. cenocepacia was reassigned to the species designation (8) . This bacterium was relatively unknown as a human pathogen until the mid-1980s, when it surfaced as a nosocomial infection at cystic fibrosis clinics (9) . Like many opportunistic pathogens, B. cepacia can establish an infection in any favorable environment.…”