Prevalence and clonality of Burkholderia cepacia complex genomovars in UK patients with cystic fibrosis referred for lung transplantation

Abstract

Background: It has previously been reported that patients infected with Burkholderia cenocepacia (genomovar III) before lung transplantation have a poorer outcome than those with other B cepacia complex infections. Methods: An extensive study was conducted to determine the prevalence and clonality of B cepacia complex genomovars isolated from patients referred for transplant assessment between 1989 to the present and, where appropriate, whether strain type was related to transplant outcome. Results: Isolates from 29 patients were identified as B cepacia complex organisms by molecular analysis. Thirteen patients (45%) were infected with the highly transmissible ET-12 strain of B cenocepacia recA lineage III-A, while all remaining patients were infected with genetically unique B cenocepacia, B multivorans, and B vietnamiensis strains. All previously reported deaths following transplantation were associated with ET-12 infection. Conclusions: The ET-12 strain is the predominant cause of B cenocepacia infections in patients with cystic fibrosis referred to our pulmonary transplant centre and is associated with poor transplant outcomes using standard treatment regimens.

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

“…Three reports compared B. multivorans-infected patients to non-BCC-infected controls and found no significant differences in mortality or decline in % predicted FEV 1 (115,296,304), whereas one small case-control study of seven BCCinfected patients (six of whom were infected with B. multivorans) showed significantly higher 6-month mortality (57% versus 16%; P ϭ 0.02) in the BCC patients (187). Still, B. multivorans has been anecdotally reported to cause the cepacia syndrome (56, 371, 538, 669), pulmonary hypertension (187), respiratory failure requiring lung transplantation (146), and death (187). In summary, the impact of B. multivorans on outcomes in CF remains poorly defined but appears to be less severe than that of B. cenocepacia.…”

Revised Approach for Identification of Isolates within the Burkholderia cepacia Complex and Description of Clinical Isolates Not Assigned to Any of the Known Genomovars

“…Reliable identification is important, since some genomovars, particularly the ET12 lineage of genomovar IIIA (15), are associated with high transmissibility between patients and a poor prognosis (7). B. multivorans and B. cenocepacia account for the majority of isolates from CF patients, with patient-to-patient spread mainly being associated with genomovars IIIA (8,12) and IIIB (3,6), although reports also describe epidemic spread of lineages of genomovar IIID (13) and B. dolosa (1,2).…”

Transmission of Burkholderia cepacia Complex: Evidence for New Epidemic Clones Infecting Cystic Fibrosis Patients in Italy

“…Chronic pulmonary B. cepacia complex infections are associated with increased rates of morbidity and mortality and in some patients are responsible for a dramatic and fatal deterioration of lung function known as cepacia syndrome (29,33). Poor outcome in lung transplant recipients has also led some clinicians to consider these infections as a contraindication to transplantation (7,19). Some CF patients may be transiently colonized, and others may be chronically or asymptomatically colonized, suggesting differences in host response or pathogenic potential among B. cepacia complex bacteria.…”