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Daccò V, Alicandro G, Consales A, Rosazza C, Sciarrabba CS, Cariani L, Colombo C. Cepacia syndrome in cystic fibrosis: A systematic review of the literature and possible new perspectives in treatment. Pediatr Pulmonol 2023; 58:1337-1343. [PMID: 36815622 DOI: 10.1002/ppul.26359] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/07/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Cepacia syndrome (CS) is an acute, necrotizing pneumonia with a high mortality rate, occurring in patients with cystic fibrosis (CF) infected with Burkholderia cepacia complex (BCC). Due to its low incidence, data on this condition are limited. METHODS We conducted a systematic review of the reported cases of CS by searching MEDLINE, Embase and the Cochrane Library to improve knowledge of this rare but potentially lethal condition. RESULTS We included 15 eligible articles, describing 18 cases (9 females) of CS. Median age at onset was 22 years (range: 10-60 years); median time to CS after first infection by BCC was 5 years (range: 1-26 years). Burkholderia cenocepacia was the most frequently reported causative agent. All patients received intravenous antibiotic treatment (most frequently including cotrimoxazole), while inhaled antibiotics were used in five patients (27.8%). Immunosuppressant agents were the most commonly prescribed supportive treatment (n = 7, 38.9%). Half of the patients died (9/18, 50%). CONCLUSIONS This study describes epidemiological, clinical characteristics, and prognosis of CS cases reported over the last 24 years. CS is a rare yet severe complication of BCC infection in patients with CF, which occurs several years after BCC colonization and has a negative outcome in 50% of the patients. Data are too scanty to identify the most effective therapeutic approach.
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Affiliation(s)
- Valeria Daccò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Center, Milan, Italy
| | - Gianfranco Alicandro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Center, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Consales
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Chiara Rosazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Center, Milan, Italy
| | - Calogero S Sciarrabba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Center, Milan, Italy
| | - Lisa Cariani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Pathology, Microbiology Unit, Milan, Italy
| | - Carla Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Center, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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2
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Ottu Para NK, Vemuri S, Koshy G, Ibrahim D, Oomen S, Reddappa SV, Nadaf MS, Irfan RM, Wyon N, Ahmed MZ, Sundaram S. Management of Cepacia syndrome in an immunocompetent non-cystic fibrosis adult patient. Int J Infect Dis 2022; 122:550-552. [PMID: 35811086 DOI: 10.1016/j.ijid.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/22/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022] Open
Abstract
Burkholderia cepacia complex (BCC) is nonfermenting, Gram-negative bacteria known to cause high morbidity and mortality. They commonly affect patients with cystic fibrosis (CF) and are often missed in those without, despite being fatal if left untreated. We report a case of cepacia syndrome in a 42-year-old, immunocompetent man without CF who initially presented with sepsis secondary to pneumonia. Multiple isolates from blood, synovial fluid, and wound swabs grew BCC. Treatment options and management strategies remain poorly understood for BCC in general and in cases without CF in specific. We successfully treated the patient using a combination of intravenous and inhalational antibiotics. This case report elaborates on the disease presentation, investigations, and management strategy employed to treat this rare infection.
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Affiliation(s)
| | - Sreya Vemuri
- Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Georgey Koshy
- Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Dima Ibrahim
- Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Seema Oomen
- Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | | | | | | | - Nicholas Wyon
- Burjeel Medical City, Abu Dhabi, United Arab Emirates
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3
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Branstetter JW, Yarbrough A, Poole C. Management of Cepacia Syndrome With a Combination of Intravenous and Inhaled Antimicrobials in a Non-Cystic Fibrosis Pediatric Patient. J Pediatr Pharmacol Ther 2020; 25:730-734. [PMID: 33214785 DOI: 10.5863/1551-6776-25.8.730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 11/11/2022]
Abstract
Burkholderia cepacia complex (Bcc) is an opportunistic pathogen, posing little risk to healthy individuals. The presentation of Bcc can vary from a virtually asymptomatic chronic infection, to an acute, life-threatening necrotizing pneumonia, acute respiratory distress syndrome, and bacteremia (cepacia syndrome) associated with a mortality rate up to 75%. We present the successful treatment of a 17-year-old male with chronic granulomatous disorder who presented with cepacia syndrome and confirmed Bcc pneumonia using a novel antimicrobial approach. Despite initial IV antimicrobial therapy, our patient continued to decline, developing hypotension requiring pressor support and eventually extracorporeal membrane oxygenation. An aggressive, multimechanistic approach including the combination of nebulized tobramycin, IV sulfamethoxazole-trimethoprim, ceftazidime, enteral minocycline, and corticosteroids was implemented. This multimechanistic antimicrobial approach in combination with systemic corticosteroids led to the successful treatment of cepacia syndrome in the setting of necrotizing pneumonia due to B cepacia with full respiratory recovery. We suggest that in patients with cepacia syndrome who continue to decline despite IV antimicrobial therapy, using multiple antimicrobial mechanisms of action may improve clinical outcomes.
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Affiliation(s)
| | - April Yarbrough
- Department of Pharmacy (JWB, AY), Children's of Alabama, Birmingham, AL
| | - Claudette Poole
- Division of Pediatric Infectious Diseases (CP), University of Alabama at Birmingham, AL
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4
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Urriola N, Williams A, Keat K. Macrophage activation syndrome/haemophagocytic lymphohistiocytosis secondary to Burkholderia cepacia complex septicaemia in an elderly female carrier of X-linked chronic granulomatous disease with extreme lyonisation: 'cepacia syndrome' revisited. BMJ Case Rep 2019; 12:12/8/e230434. [PMID: 31473638 DOI: 10.1136/bcr-2019-230434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
X-linked carriers of chronic granulomatous disease (CGD) may become phenotypically affected if substantial skewing from lyonisation occurs. We describe a 73-year-old female carrier with an overt CGD phenotype due to skewed lyonisation, complicated by macrophage activation syndrome (MAS)/haemophagocytic lymphohistiocytosis (HLH) secondary to Burkholderiacepacia complex septicaemia that was successfully treated with a combination of three antibiotics, an antifungal, granulocyte colony stimulating factor, intravenous immune globulin (IVIG) and ciclosporin. Fully phenotypic immunodeficiency is possible in X-linked CGD carriers when skewed lyonisation occurs, rendering such patients to all the same sequelae of CGD such as MAS/HLH. MAS/HLH should be thoroughly excluded when evaluating 'cepacia syndrome' in non-CGD patients.
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Affiliation(s)
- Nicolás Urriola
- Immunology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Andrew Williams
- Immunopathology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Karuna Keat
- Immunology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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5
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Lim BA, Lopez A, Buensalido JA. Refractory Burkholderia cepacia bacteraemia from a consolidation pneumonia lasting more than 7 weeks, successfully treated with systemic antibiotics and nebulised meropenem. BMJ Case Rep 2019; 12:12/8/e229566. [PMID: 31377717 DOI: 10.1136/bcr-2019-229566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 55-year-old Filipino man who was transferred from another institution where he was recently diagnosed with Crohn's disease but not started on any immunosuppressants. He underwent laparoscopic cholecystectomy with T-tube placement a few weeks prior to admission. On workup, abdominal CT scan was unremarkable, but blood cultures on the third hospital day grew Burkholderia cepacia Antibiotic regimen was shifted to ceftazidime and levofloxacin. The bacteraemia and febrile episodes persisted despite removal of the central line and T tube. White blood cell scan and chest CT scan showed left-sided consolidation pneumonia. Blood cultures continued to grow B. cepacia despite shifting to meropenem and trimethoprim-sulfamethoxazole. Meropenem nebulisation at 250 mg every 12 hours was added to the regimen on the third week then oral minocycline was added on the fourth week due to persistence of bacteraemia. He subsequently developed a small vegetation on the aortic valve, so amikacin was added. Fever lysed on the sixth week, but the B. cepacia bacteraemia persisted, clearing only on the 51st hospital day. The patient was discharged with a plan to continue antibiotics, including meropenem nebulisation, for 6 more weeks. On follow-up, the patient had no recurrence of fever. There was also resolution of consolidation on chest CT scan and disappearance of vegetation on echocardiography.
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Affiliation(s)
- Bryan Albert Lim
- Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Adelaine Lopez
- Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Joseph Adrian Buensalido
- Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
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6
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Scoffone VC, Chiarelli LR, Trespidi G, Mentasti M, Riccardi G, Buroni S. Burkholderia cenocepacia Infections in Cystic Fibrosis Patients: Drug Resistance and Therapeutic Approaches. Front Microbiol 2017; 8:1592. [PMID: 28878751 PMCID: PMC5572248 DOI: 10.3389/fmicb.2017.01592] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/04/2017] [Indexed: 12/29/2022] Open
Abstract
Burkholderia cenocepacia is an opportunistic pathogen particularly dangerous for cystic fibrosis (CF) patients. It can cause a severe decline in CF lung function possibly developing into a life-threatening systemic infection known as cepacia syndrome. Antibiotic resistance and presence of numerous virulence determinants in the genome make B. cenocepacia extremely difficult to treat. Better understanding of its resistance profiles and mechanisms is crucial to improve management of these infections. Here, we present the clinical distribution of B. cenocepacia described in the last 6 years and methods for identification and classification of epidemic strains. We also detail new antibiotics, clinical trials, and alternative approaches reported in the literature in the last 5 years to tackle B. cenocepacia resistance issue. All together these findings point out the urgent need of new and alternative therapies to improve CF patients’ life expectancy.
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Affiliation(s)
- Viola C Scoffone
- Department of Biology and Biotechnology, University of PaviaPavia, Italy
| | | | - Gabriele Trespidi
- Department of Biology and Biotechnology, University of PaviaPavia, Italy
| | - Massimo Mentasti
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health EnglandLondon, United Kingdom.,Department of Microbiology, Royal Cornwall HospitalTruro, United Kingdom
| | - Giovanna Riccardi
- Department of Biology and Biotechnology, University of PaviaPavia, Italy
| | - Silvia Buroni
- Department of Biology and Biotechnology, University of PaviaPavia, Italy
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7
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An 87-Year-Old Man with Acute Catastrophic Pneumonia. Ann Am Thorac Soc 2016; 13:432-7. [PMID: 26963355 DOI: 10.1513/annalsats.201507-418cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Sainsbury AW, Yu-Mei R, Ågren E, Vaughan-Higgins RJ, Mcgill IS, Molenaar F, Peniche G, Foster J. Disease Risk Analysis and Post-Release Health Surveillance for a Reintroduction Programme: the Pool Frog Pelophylax lessonae. Transbound Emerg Dis 2016; 64:1530-1548. [PMID: 27393743 DOI: 10.1111/tbed.12545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Indexed: 11/30/2022]
Abstract
There are risks from disease in undertaking wild animal reintroduction programmes. Methods of disease risk analysis have been advocated to assess and mitigate these risks, and post-release health and disease surveillance can be used to assess the effectiveness of the disease risk analysis, but results for a reintroduction programme have not to date been recorded. We carried out a disease risk analysis for the reintroduction of pool frogs (Pelophylax lessonae) to England, using information gained from the literature and from diagnostic testing of Swedish pool frogs and native amphibians. Ranavirus and Batrachochytrium dendrobatidis were considered high-risk disease threats for pool frogs at the destination site. Quarantine was used to manage risks from disease due to these two agents at the reintroduction site: the quarantine barrier surrounded the reintroduced pool frogs. Post-release health surveillance was carried out through regular health examinations of amphibians in the field at the reintroduction site and collection and examination of dead amphibians. No significant health or disease problems were detected, but the detection rate of dead amphibians was very low. Methods to detect a higher proportion of dead reintroduced animals and closely related species are required to better assess the effects of reintroduction on health and disease.
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Affiliation(s)
- A W Sainsbury
- Institute of Zoology, Zoological Society of London, London, UK
| | - R Yu-Mei
- Royal Veterinary College, London, UK
| | - E Ågren
- National Veterinary Institute, Uppsala, Sweden
| | | | - I S Mcgill
- Institute of Zoology, Zoological Society of London, London, UK.,Prion Interest Group, Brighton, UK
| | - F Molenaar
- Institute of Zoology, Zoological Society of London, London, UK
| | - G Peniche
- Institute of Zoology, Zoological Society of London, London, UK
| | - J Foster
- Amphibian and Reptile Conservation, Wareham, Dorset, UK
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9
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Cepacia Syndrome in a Non-Cystic Fibrosis Patient. Case Rep Infect Dis 2015; 2015:537627. [PMID: 26357579 PMCID: PMC4555446 DOI: 10.1155/2015/537627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/03/2015] [Indexed: 11/29/2022] Open
Abstract
Burkholderia (formerly Pseudomonas) cepacia complex is a known serious threat to patients with cystic fibrosis, in whom it has the potential to cause the fatal combination of necrotizing pneumonia, worsening respiratory failure, and bacteremia, known as Cepacia syndrome. The potential for this pathogen to infect non-cystic fibrosis patients is limited and its epidemiology is poorly understood. Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions. We present a case of a 64-year-old man with Streptococcus pneumoniae community-acquired pneumonia whose hospital course was complicated by developing cavitary lung lesions, bacteremia, and acute respiratory distress syndrome. Repeated tracheal aspirate and blood cultures grew Burkholderia cepacia. Our case appears to be the first report of Cepacia syndrome in a patient without cystic fibrosis. This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome. A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.
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10
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Gautam V, Shafiq N, Singh M, Ray P, Singhal L, Jaiswal NP, Prasad A, Singh S, Agarwal A. Clinical and in vitro evidence for the antimicrobial therapy in Burkholderia cepacia complex infections. Expert Rev Anti Infect Ther 2015; 13:629-63. [PMID: 25772031 DOI: 10.1586/14787210.2015.1025056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Treatment of infections caused by Burkholderia cepacia complex (Bcc) in cystic fibrosis (CF) patients poses a complex problem. Bcc is multidrug-resistant due to innate and acquired mechanisms of resistance. As CF patients receive multiple courses of antibiotics, susceptibility patterns of strains from CF patients may differ from those noted in strains from non-CF patients. Thus, there was a need for assessing in vitro and clinical data to guide antimicrobial therapy in these patients. A systematic search of literature, followed by extraction and analysis of available information from human and in vitro studies was done. The results of the analysis are used to address various aspects like use of antimicrobials for pulmonary and non-pulmonary infections, use of combination versus monotherapy, early eradication, duration of therapy, route of administration, management of biofilms, development of resistance during therapy, pharmacokinetics-pharmacodynamics correlations, therapy in post-transplant patients and newer drugs in Bcc-infected CF patients.
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Affiliation(s)
- Vikas Gautam
- Deparatment of Medical Microbiology, PGIMER, Chandigarh 160022, India
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11
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Successful Treatment of Severe Pneumonia Caused by Burkholderia cenocepacia With Intravenous Antibiotics and Immunosuppression Under Extracorporal Membrane Oxygenation. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Falagas ME, Trigkidis KK, Vardakas KZ. Inhaled antibiotics beyond aminoglycosides, polymyxins and aztreonam: A systematic review. Int J Antimicrob Agents 2014; 45:221-33. [PMID: 25533880 DOI: 10.1016/j.ijantimicag.2014.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 11/15/2022]
Abstract
We sought to evaluate published evidence regarding clinical or microbiological outcomes related to the use of inhaled antibiotics other than aminoglycosides, polymyxins and aztreonam. A systematic search of PubMed and Scopus databases as well as bibliographies of eligible articles was performed. In total, 34 eligible studies were identified. Among several inhaled β-lactams, ceftazidime was used with varying success in the prevention and treatment of ventilator-associated pneumonia (VAP) and improved clinical outcomes in chronic Pseudomonas aeruginosa lower respiratory tract infections (LRTIs) in patients with cystic fibrosis (CF) or bronchiectasis. Inhaled vancomycin, as an adjunctive therapy, was effective in treating Gram-positive VAP, whilst inhaled levofloxacin, ciprofloxacin and an inhaled combination of fosfomycin and tobramycin were associated with improved microbiological or clinical outcomes in chronic LRTI in patients with CF or bronchiectasis. In conclusion, published evidence is heterogeneous with regard to antibiotics used, studied indications, patient populations and study designs. Therefore, although the currently available data are encouraging, no safe conclusion regarding the effectiveness and safety of the drugs in question can be reached.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Internal Medicine-Infectious Diseases, Iaso General Hospital, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | | | - Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Internal Medicine-Infectious Diseases, Iaso General Hospital, Athens, Greece
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13
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Kirkby S, Novak K, McCoy K. Update on antibiotics for infection control in cystic fibrosis. Expert Rev Anti Infect Ther 2014; 7:967-80. [DOI: 10.1586/eri.09.82] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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14
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Lobo LJ, Noone PG. Respiratory infections in patients with cystic fibrosis undergoing lung transplantation. THE LANCET RESPIRATORY MEDICINE 2013; 2:73-82. [PMID: 24461904 DOI: 10.1016/s2213-2600(13)70162-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cystic fibrosis is an inherited disease characterised by chronic respiratory infections associated with bronchiectasis. Lung transplantation has helped to extend the lives of patients with cystic fibrosis who have advanced lung disease. However, persistent, recurrent, and newly acquired infections can be problematic. Classic cystic fibrosis-associated organisms, such as Staphylococcus aureus and Pseudomonas aeruginosa, are generally manageable post-transplantation, and are associated with favourable outcomes. Burkholderia cenocepacia poses particular challenges, although other Burkholderia species are less problematic. Despite concerns about non-tuberculous mycobacteria, especially Mycobacterium abscessus, post-transplantation survival has not been definitively shown to be less than average in patients with these infections. Fungal species can be prevalent before and after transplantation and are associated with high morbidity, so should be treated aggressively. Appropriate viral screening and antiviral prophylaxis are necessary to prevent infection with and reactivation of Epstein-Barr virus and cytomegalovirus and their associated complications. Awareness of drug pharmacokinetics and interactions in cystic fibrosis is crucial to prevent toxic effects and subtherapeutic or supratherapeutic drug dosing. With the large range of potential infectious organisms in patients with cystic fibrosis, infection control in hospital and outpatient settings is important. Despite its complexity, lung transplantation in the cystic fibrosis population is safe, with good outcomes if the clinician is aware of all the potential pathogens and remains vigilant by means of surveillance and proactive treatment.
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Affiliation(s)
- Leonard J Lobo
- Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Peadar G Noone
- Pulmonary Division, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
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15
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Correa-Ruiz A, Girón R, Buendía B, Medina-Pascual MJ, Valenzuela C, López-Brea M, Sáez-Nieto JA. Burkholderia cepacia complex infection in an Adult Cystic Fibrosis unit in Madrid. Enferm Infecc Microbiol Clin 2013; 31:649-54. [PMID: 23528342 DOI: 10.1016/j.eimc.2012.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/30/2012] [Accepted: 12/04/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Burkholderia cepacia complex have emerged as significant pathogens in cystic fibrosis (CF) patients due to the risk of cepacia syndrome and the innate multi-resistance of the microorganisms to antibiotics. The aim of this study was to describe the antimicrobial susceptibility profiles, the genotypes and subtypes of BCC, and the clinical evolution of CF patients with BCC. METHODS The lung function and Brasfield and Shwachman score were assessed in 12 patients. BCC were identified and susceptibility was studied by MicroScan (Siemens). Species and genospecies of BCC were confirmed by molecular methods in a Reference Centre (Majadahonda). RESULTS BCC were identified in 12 of 70 patients (17.1%) over a ten year period. The mean age to colonization by BCC was 24.4 years (SD: 7.71). B. cenocepacia was isolated in 4 patients (33.3%), B. contaminans was isolated in 3 patients (25%), both B. vietnamiensis and B. stabilis were isolated in 2 patients (16.7%), and B. cepacia, B. multivorans and B. late were isolated in one patient (8.3%). Among the B. cenocepacia, subtype IIIa was identified in two strains, and subtype IIIb was identified in the other two strains. There was susceptibility to meropenem in 90% of BCC, 80% to cotrimoxazole, 60% to minocycline, 50% to ceftazidime, and 40% to levofloxacin. CONCLUSIONS B. cenocepacia was the most prevalent species among the BCC isolated in CF adult patients, and subtypes IIIa and IIIb were identified in the 50% of the strains. Meropenem and cotrimoxazole showed the best activity.
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Affiliation(s)
- Ana Correa-Ruiz
- Servicio de Microbiología, Instituto de Investigación Sanitaria, Hospital de La Princesa, Madrid, Spain.
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16
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Gilchrist FJ, Webb AK, Bright-Thomas RJ, Jones AM. Successful treatment of cepacia syndrome with a combination of intravenous cyclosporin, antibiotics and oral corticosteroids. J Cyst Fibros 2012; 11:458-60. [DOI: 10.1016/j.jcf.2012.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/10/2012] [Indexed: 11/28/2022]
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17
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Horsley A, Webb K, Bright-Thomas R, Govan J, Jones A. Can early Burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy? Front Cell Infect Microbiol 2011; 1:18. [PMID: 22919584 PMCID: PMC3417365 DOI: 10.3389/fcimb.2011.00018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 11/30/2011] [Indexed: 11/13/2022] Open
Abstract
Introduction: Organisms of the Burkholderia cepacia complex (BCC) are important pathogens in cystic fibrosis (CF). The majority of those who acquire BCC develop chronic infection but it can also result in rapid decline in a significant minority. In addition, chronic infection with Burkholderia cenocepacia in particular is regarded as a contraindication to lung transplantation in many units. Whilst aggressive antibiotic therapy is employed in CF to eradicate Pseudomonas aeruginosa before infection becomes irreversibly established, no formal assessment of such strategies has been previously reported for BCC, despite the apparent widespread adoption of this practice. Methods: UK adult CF centers were surveyed about their current approach to new BCC infection. Outcomes of eradication therapy were assessed in patients attending the Manchester Adult CF Center with new BCC isolates between 1st January 2002 and 1st May 2011. Patients with previous infection with the same strain of BCC were excluded. BCC were identified at the national reference laboratories and confirmed by species-specific PCR and RecA sequencing. Results: Routine use of therapies to attempt eradication of new BCC is commonly used in the UK (12/17 centers who responded). This typically involves a combination of intravenous and nebulised antibiotics. Of 19 eligible cases of new BCC infection, the organism has been eradicated in 7 (37%). Three of these did not receive specific eradication therapy. Of 14 patients who have received eradication therapy and completed follow up, BCC were cleared in only 4 (29%). Conclusions: Attempted eradication of new BCC is a common practice in UK adult CF centers. A minority of patients clear the infection spontaneously and the effects of eradication therapies are at best modest. Early treatment may be associated with better outcomes, though there are insufficient data to support the use of any specific treatment regimen. A prospective, systematic evaluation of treatments and outcomes is required.
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Affiliation(s)
- Alex Horsley
- Manchester Adult Cystic Fibrosis Center, University Hospitals South Manchester Manchester, UK; Respiratory Research Group, School of Translational Medicine, University of Manchester, Manchester, UK.
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18
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Nash E, Coonar A, Kremer R, Tullis E, Hutcheon M, Singer L, Keshavjee S, Chaparro C. Survival of Burkholderia cepacia sepsis following lung transplantation in recipients with cystic fibrosis. Transpl Infect Dis 2010; 12:551-4. [DOI: 10.1111/j.1399-3062.2010.00525.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peeters E, Nelis HJ, Coenye T. In vitro activity of ceftazidime, ciprofloxacin, meropenem, minocycline, tobramycin and trimethoprim/sulfamethoxazole against planktonic and sessile Burkholderia cepacia complex bacteria. J Antimicrob Chemother 2009; 64:801-9. [PMID: 19633000 DOI: 10.1093/jac/dkp253] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of the present study was to obtain a comprehensive overview of the bacteriostatic and bactericidal effects of six commonly used antibiotics on planktonic as well as on sessile Burkholderia cepacia complex cells. METHODS The bacteriostatic and bactericidal activities of ceftazidime, ciprofloxacin, meropenem, minocycline, tobramycin and trimethoprim/sulfamethoxazole were determined against 38 B. cepacia complex strains. MICs and minimal biofilm inhibitory concentrations (MBICs) were determined using a traditional broth microdilution method and a novel resazurin-based viability staining, respectively. The bactericidal effects of the investigated antibiotics (using antibiotic concentrations corresponding to 10 x MIC; except for tobramycin, for which a final concentration of 4 x MIC was tested) on stationary phase planktonic cultures and on 24-h-old biofilms were evaluated using conventional plate count methods. RESULTS Our results confirm the innate resistance of B. cepacia complex organisms to six first-line antibiotics used to treat infected cystic fibrosis patients. All antibiotics showed similar bacteriostatic activities against exponentially growing B. cepacia complex planktonic cells and freshly adhered sessile cells (4 h). In addition, most of the antibiotics showed similar bactericidal effects on stationary phase planktonic cultures and on young and older biofilms. CONCLUSIONS Despite the general assumption that sessile cells show a decreased susceptibility to antibiotics, our data indicate similar bacteriostatic and bactericidal activity of six selected antibiotics against planktonic and sessile B. cepacia complex bacteria.
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Affiliation(s)
- Elke Peeters
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Successful treatment of cepacia syndrome. J Cyst Fibros 2009; 8:291-3. [DOI: 10.1016/j.jcf.2009.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 04/09/2009] [Accepted: 04/12/2009] [Indexed: 11/18/2022]
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