What is Burkholderia (formerly known as Pseudomonas cepacia)?

From the Guidelines

Burkholderia infections, particularly those caused by Pseudomonas aeruginosa, are associated with high morbidity and mortality, and treatment should be initiated promptly with a combination of high-dose antipseudomonal penicillins and aminoglycosides, such as tobramycin and ceftazidime, for a minimum of 6 weeks 1.

Key Considerations

• The disease carries a high mortality rate, especially in patients over 30 years of age, with left-sided cardiac involvement, and when the duration of illness is prolonged 1.
• Medical therapy may be successful in right-sided Pseudomonas endocarditis in 50% to 75% of cases, but surgery is often necessary for left-sided involvement 1.
• The preferred regimen for IE caused by P aeruginosa is high-dose tobramycin with an extended-spectrum penicillin or ceftazidime, with maintenance of peak and trough concentrations to minimize toxicity 1.

Treatment Challenges

• Burkholderia infections are challenging to treat due to their intrinsic resistance to multiple antibiotics 1.
• The formation of biofilms and survival within host cells contribute to the persistence and treatment difficulty of these infections 1.

Prevention Strategies

• Infection control measures in healthcare settings and avoiding exposure to contaminated soil or water in endemic regions can help prevent Burkholderia infections 1.

From the Research

Overview of Burkholderia

• Burkholderia cepacia complex (BCC) is a group of pathogens that can affect patients with cystic fibrosis, chronic granulomatous disease, and immunocompromised or hospitalized patients 2.
• BCC infections are challenging to treat due to high levels of resistance to many antimicrobial agents 2, 3.

Treatment Options

• Co-trimoxazole (trimethoprim/sulfamethoxazole) is a commonly used treatment for BCC infections, but alternative options are needed due to allergic reactions, intolerance, or resistance 2.
• Ceftazidime, meropenem, and penicillins (mainly piperacillin) may be considered as alternative options for BCC infections, based on in vitro antimicrobial susceptibility patterns and clinical results 2, 3, 4.
• Ceftazidime/avibactam has shown high susceptibility rates against BCC isolates, with 78% of isolates being susceptible 3.

Antibiotic Resistance and Collateral Sensitivity

• BCC isolates often exhibit high levels of resistance to many antibiotics, including ceftazidime, meropenem, and levofloxacin 3, 4.
• However, some studies have found that BCC exhibits antibiotic collateral sensitivity, where acquired resistance to one antibiotic results in decreased resistance to another antibiotic 5.
• This phenomenon may lead to sustainable treatment regimens that reduce the development of multidrug-resistant bacterial strains 5.

Clinical Outcomes and Management

• The management and outcomes of BCC bacteremia in patients without cystic fibrosis have been studied, with early removal of central venous catheters found to be crucial in treatment 4.
• The 14-day, 30-day, and in-hospital mortality rates for BCC bacteremia in non-cystic fibrosis patients were 19.4%, 23.1%, and 31.0%, respectively 4.
• Female sex, liver cirrhosis, septic shock, and catheter-related infection were identified as independent risk factors for 30-day mortality 4.