From the Guidelines
The recommended treatment for Burkholderia multivorans infections involves combination antibiotic therapy, with a suggested regimen including two in vitro active antibiotics among available options such as polymyxin, aminoglycoside, tigecycline, and sulbactam combinations for severe and high-risk infections 1. When considering treatment for Burkholderia multivorans infections, it's crucial to prioritize combination therapy due to the organism's intrinsic resistance to many antibiotics. Key points to consider include:
- The use of combination therapy including two in vitro active antibiotics among the available antibiotics for severe and high-risk infections 1.
- Avoiding polymyxin-meropenem combination therapy and polymyxin-rifampin combination therapy due to strong recommendations against their use 1.
- Considering carbapenem combination therapy with high-dose extended-infusion carbapenem dosing for patients with meropenem MIC <8 mg/L as good clinical practice 1. The treatment approach should be tailored based on the severity of the infection, clinical response, and antibiotic susceptibility testing results. Given the complexity of treating Burkholderia multivorans infections due to its ability to form biofilms and persist intracellularly, prolonged therapy is often necessary. For patients with specific conditions like cystic fibrosis, more aggressive and extended treatment approaches may be required.
From the Research
Treatment Options for Burkholderia multivorans Infections
The treatment of Burkholderia multivorans infections is challenging due to the bacterium's inherent resistance to multiple antibiotics. However, several studies have investigated the effectiveness of various treatment options:
- Ceftazidime-avibactam combination: This combination has shown promise in treating Burkholderia multivorans infections, with studies demonstrating its ability to restore susceptibility to ceftazidime 2, 3, 4.
- Trimethoprim/sulfamethoxazole: This antibiotic combination has been found to have a high susceptibility rate against Burkholderia cepacia complex isolates, including B. multivorans 3.
- Meropenem and ceftazidime: These antibiotics have been shown to be active against B. multivorans, although their effectiveness can be limited by the development of resistance 5, 6.
Antibiotic Resistance and Sensitivity
Burkholderia multivorans is known to develop resistance to antibiotics, including ceftazidime, which can limit treatment options:
- The rapid emergence of ceftazidime-resistant B. multivorans strains has been observed in patients with cystic fibrosis 5.
- The use of avibactam, a β-lactamase inhibitor, can help restore susceptibility to ceftazidime in B. multivorans isolates 2, 3.
- Synergy between antibiotics, such as aztreonam and avibactam, has been investigated, but its effectiveness against B. multivorans is limited 3.
Clinical Implications
The treatment of Burkholderia multivorans infections requires careful consideration of antibiotic resistance and sensitivity:
- Ceftazidime-avibactam combination therapy has been successfully used to treat B. multivorans infections in patients with cystic fibrosis 4.
- The use of trimethoprim/sulfamethoxazole and other antibiotics may be effective against B. multivorans, but their effectiveness can be limited by resistance 3.
- Monitoring antibiotic susceptibility is crucial to managing patient care and preventing the development of resistance 5.