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Gauvreau A, Carrier FM, Poirier C, Morisset J, Lands LC, Lavoie A, Nasir B, Ferraro P, Luong ML. Post-transplant outcomes among cystic fibrosis patients undergoing lung transplantation colonized by Burkholderia: A single center cohort study. J Heart Lung Transplant 2023; 42:917-924. [PMID: 36894412 DOI: 10.1016/j.healun.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Prior infection with Burkholderia cepacia complex (BCC) has been associated with poorer outcomes after lung transplantation, posing an important dilemma for cystic fibrosis (CF). Although current guidelines consider BCC infection to be a relative contraindication, some centers continue to offer lung transplantation to BCC-infected CF patients. METHODS We conducted a retrospective cohort study which included all consecutive CF-LTR between 2000 and 2019 to compare the postoperative survival of BCC-infected CF lung transplant recipients (CF-LTR) to BCC-uninfected patients. We used a Kaplan-Meier analysis to compare survival of BCC-infected to BCC-uninfected CF-LTR and fitted a multivariable Cox model, adjusted for age, sex, BMI and year of transplantation as potential confounders. As an exploratory analysis, Kaplan-Meier curves were also stratified by the presence of BCC and urgency of transplantation. RESULTS A total of 205 patients were included with a mean age of 30.5 years. Seventeen patients (8%) were infected with BCC prior to LT. Patients were infected with the following species: B. multivorans5, B. vietnamiensis3, combined B. multivorans and B. vietnamiensis3 and others4. None of the patients were infected with B. cenocepacia. Three patients were infected with B. gladioli. One-year survival was 91.7% (188/205) for the entire cohort, 82.4% (14/17) among BCC-infected CF-LTR, and 92.5% (173/188) among BCC uninfected CF-LTR (crude HR = 2.19; 95%CI 0.99-4.85; p = 0.05). In the multivariable model, presence of BCC was not significantly associated with worse survival (adjusted HR 1.89; 95%CI 0.85-4.24; p = 0.12). In the stratified analysis for both presence of BCC and urgency of transplantation, urgency of transplantation among BCC-infected CF-LTR appeared to be associated with poorer outcome (p = 0.003 across the 4 subgroups). CONCLUSION Our results suggest that non-cenocepacia BCC-infected CF-LTR have comparable survival rate to BCC-uninfected CF-LTR.
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Affiliation(s)
- Andréa Gauvreau
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - François M Carrier
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Medicine, Critical care service, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Carrefour de l'innovation et santé des populations, Centre de recherche du CHUM, Montréal, Quebec, Canada
| | - Charles Poirier
- Department of Medicine, Division of Respirology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Julie Morisset
- Department of Medicine, Division of Respirology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Larry C Lands
- Department of Medicine, Division of Respirology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Annick Lavoie
- Department of Medicine, Division of Respirology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Basil Nasir
- Department of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Department of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Me-Linh Luong
- Department of Medicine, Division of Infectious Diseases, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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Hayes AJ, Lewis JM, Davies MR, Scott NE. Burkholderia PglL enzymes are Serine preferring oligosaccharyltransferases which target conserved proteins across the Burkholderia genus. Commun Biol 2021; 4:1045. [PMID: 34493791 PMCID: PMC8423747 DOI: 10.1038/s42003-021-02588-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
Glycosylation is increasingly recognised as a common protein modification within bacterial proteomes. While great strides have been made in identifying species that contain glycosylation systems, our understanding of the proteins and sites targeted by these systems is far more limited. Within this work we explore the conservation of glycoproteins and glycosylation sites across the pan-Burkholderia glycoproteome. Using a multi-protease glycoproteomic approach, we generate high-confidence glycoproteomes in two widely utilized B. cenocepacia strains, K56-2 and H111. This resource reveals glycosylation occurs exclusively at Serine residues and that glycoproteins/glycosylation sites are highly conserved across B. cenocepacia isolates. This preference for glycosylation at Serine residues is observed across at least 9 Burkholderia glycoproteomes, supporting that Serine is the dominant residue targeted by PglL-mediated glycosylation across the Burkholderia genus. Combined, this work demonstrates that PglL enzymes of the Burkholderia genus are Serine-preferring oligosaccharyltransferases that target conserved and shared protein substrates. Hayes et al provide a glycosylation site focused analysis of the glycoproteome of two widely utilized B. cenocepacia strains, K56-2 and H111. This team demonstrates that within these glycoproteomes Serine is the sole residue targeted for protein glycosylation and that glycoproteins/glycosylation sites are highly conserved across B. cenocepacia isolates.
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Affiliation(s)
- Andrew J Hayes
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jessica M Lewis
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Nichollas E Scott
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
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Clinical Outcomes Associated with Burkholderia cepacia Complex Infection in Patients with Cystic Fibrosis. Ann Am Thorac Soc 2021; 17:1542-1548. [PMID: 32678679 DOI: 10.1513/annalsats.202003-204oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Little is known in contemporary cystic fibrosis (CF) cohorts about the outcomes after new Burkholderia species infections.Objectives: To evaluate the changing epidemiology and clinical outcomes associated with Burkholderia species infections in persons with CF.Methods: A cohort study of children and adults with CF was conducted from 1997 to 2018 in Toronto, Canada. Patients were characterized as those with no history of Burkholderia species infection and as those who were culture-positive for Burkholderia species for the first time in this time frame and were categorized by species (B. gladioli, B. cenocepacia, B. multivorans, or other) and strain (B. cenocepacia ET-12). Cox models were used to estimate the risk of death or transplantation. Mixed-effects models were used to assess the impact of Burkholderia species on odds of pulmonary exacerbations and effect on lung function (percentage predicted forced expiratory volume in 1 second [FEV1]).Results: A total of 1,196 patients were followed over 20 years; 88 patients (7.4%) had one or more culture-positive for Burkholderia species. Patients with ET-12 infection had a median time to death of 1.95 years compared with 5.30-6.72 years for those with other Burkholderia infections. ET-12 infection was associated with a greater risk of death or transplantation compared with patients with no history of Burkholderia infection in a univariate model (hazard ratio, 3.92; 95% confidence interval 2.25-6.81) but was no longer significant after adjusting for confounders. Pulmonary exacerbations were more common in those with Burkholderia infections and remained significant in the ET-12 group after adjusting for confounders (odds ratio, 2.96; 95% confidence interval, 1.17-7.53). No differences were noted in baseline FEV1% or the rate of FEV1% decline between the groups with and without Burkholderia species infection.Conclusions: With the exception of ET-12, the acquisition of Burkholderia species infection did not appear to worsen clinical outcomes compared with those with no history of infection. Given this, prognosis, management and clinical trial inclusion protocols may need to be reevaluated for persons with Burkholderia infection.
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Mitchell AB, Glanville AR. The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes. Semin Respir Crit Care Med 2021; 42:436-448. [PMID: 34030205 DOI: 10.1055/s-0041-1728797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Pseudomonas and Burkholderia are gram-negative organisms that achieve colonization within the lungs of patients with cystic fibrosis, and are associated with accelerated pulmonary function decline. Multidrug resistance is a hallmark of these organisms, which makes eradication efforts difficult. Furthermore, the literature has outlined increased morbidity and mortality for lung transplant (LTx) recipients infected with these bacterial genera. Indeed, many treatment centers have considered Burkholderia cepacia infection an absolute contraindication to LTx. Ongoing research has delineated different species within the B. cepacia complex (BCC), with significantly varied morbidity and survival profiles. This review considers the current evidence for LTx outcomes between the different subspecies encompassed within these genera as well as prophylactic and management options. The availability of meta-genomic tools will make differentiation between species within these groups easier in the future, and will allow more evidence-based decisions to be made regarding suitability of candidates colonized with these resistant bacteria for LTx. This review suggests that based on the current evidence, not all species of BCC should be considered contraindications to LTx, going forward.
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Affiliation(s)
- Alicia B Mitchell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Allan R Glanville
- Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
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Vonberg RP, Gastmeier P. Isolation of Infectious Cystic Fibrosis Patients: Results of a Systematic Review. Infect Control Hosp Epidemiol 2016; 26:401-9. [PMID: 15865277 DOI: 10.1086/502558] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:Respiratory tract infections significantly contribute to morbidity and mortality among cystic fibrosis (CF) patients. Therefore, pathogen transmission needs to be prevented. There are several guidelines for the care of CF patients, but no transparent systematic literature review has been published.Methods:We conducted a systematic literature review (January 1966 to September 2004) dealing with segregation of CF patients colonized withBurkholderia cepaciaspecies,Pandoraeaspecies,Pseudomonas aeruginosa, Stenotrophomonas maltophilia,orAlcaligenesspecies. Quality of studies was evaluated by taking patient population size, existence of control-patients, patient randomization, diagnostic approach, and bacteria typing methods into account.Results:One hundred ninety-nine studies were found. Evidence and quality of 102 publications were evaluated. In 99 publications, recommendations concerning segregation measures for infectious CF patients were determined including a total of 11,576 patients. No randomized, controlled trials had been conducted. Fifty of 56 authors strongly recommended isolation of CF patients infected withB. cepaciaorPandoraeaspecies. In 31 of 39 studies, interpatient spread ofPseudomonas aeruginosawas documented or had been brought to an end by isolation of patients. Only five studies had addressed S.maltophiliaorAlcaligenesspecies.Conclusions:Patients colonized withB. cepaciaorPandoraeaspecies are to be separated from noncolonized patients in single rooms. Patients harboring multidrug-resistantPseudomonas aeruginosa, S. maltophilia,orAlcaligenesspecies may not share a room with immunocompromised patients, in intensive care units, or with other CF patients anywhere in the hospital.
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Affiliation(s)
- Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany.
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Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC, O’Malley C, Pattee SR, Potter-Bynoe G, Reid S, Robinson KA, Sabadosa KA, Schmidt HJ, Tullis E, Webber J, Weber DJ. Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 1:S1-S67. [DOI: 10.1086/676882] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:1.The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.2.Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistantStaphylococcus aureus(MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
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Clinafloxacin for Treatment of Burkholderia cenocepacia Infection in a Cystic Fibrosis Patient. Antimicrob Agents Chemother 2016. [PMID: 26722110 DOI: 10.1128/aac.01428-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Respiratory infection with Burkholderia cenocepacia is associated with accelerated decline in lung function and increased mortality in cystic fibrosis (CF) patients (A. M. Jones, M. E. Dodd, J. R. W. Govan, V. Barcus, C. J. Doherty, J. Morris, and A. K. Webb, Thorax 59:948-951, 2004, http://dx.doi.org/10.1136/thx.2003.017210). B. cenocepacia often possesses innate resistance to multiple antimicrobial classes, making eradication uncommon in established infection (P. B. Davis, Am J Respir Crit Care Med 173:475-482, 2006, http://dx.doi.org/10.1164/rccm.200505-840OE). We report the use of clinafloxacin in a CF patient with advanced B. cenocepacia infection, present pharmacokinetic (PK) data, and discuss the potential therapeutic role of clinafloxacin in patients with this condition.
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Balwan A, Nicolau DP, Wungwattana M, Zuckerman JB, Waters V. Clinafloxacin for Treatment of Burkholderia cenocepacia Infection in a Cystic Fibrosis Patient. Antimicrob Agents Chemother 2016; 60:1-5. [PMID: 26722110 PMCID: PMC4704148 DOI: 10.1128/aac.masthead.60-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Respiratory infection with Burkholderia cenocepacia is associated with accelerated decline in lung function and increased mortality in cystic fibrosis (CF) patients (A. M. Jones, M. E. Dodd, J. R. W. Govan, V. Barcus, C. J. Doherty, J. Morris, and A. K. Webb, Thorax 59:948-951, 2004, http://dx.doi.org/10.1136/thx.2003.017210). B. cenocepacia often possesses innate resistance to multiple antimicrobial classes, making eradication uncommon in established infection (P. B. Davis, Am J Respir Crit Care Med 173:475-482, 2006, http://dx.doi.org/10.1164/rccm.200505-840OE). We report the use of clinafloxacin in a CF patient with advanced B. cenocepacia infection, present pharmacokinetic (PK) data, and discuss the potential therapeutic role of clinafloxacin in patients with this condition.
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Affiliation(s)
- Akshu Balwan
- Division of Pulmonary & Critical Care, Maine Medical Center, Portland, Maine, USA
| | - David P Nicolau
- Center for Anti-Infective Research & Development, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Jonathan B Zuckerman
- Division of Pulmonary & Critical Care, Maine Medical Center, Portland, Maine, USA
| | - Valerie Waters
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Hanuszkiewicz A, Pittock P, Humphries F, Moll H, Rosales AR, Molinaro A, Moynagh PN, Lajoie GA, Valvano MA. Identification of the flagellin glycosylation system in Burkholderia cenocepacia and the contribution of glycosylated flagellin to evasion of human innate immune responses. J Biol Chem 2014; 289:19231-44. [PMID: 24841205 DOI: 10.1074/jbc.m114.562603] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Burkholderia cenocepacia is an opportunistic pathogen threatening patients with cystic fibrosis. Flagella are required for biofilm formation, as well as adhesion to and invasion of epithelial cells. Recognition of flagellin via the Toll-like receptor 5 (TLR5) contributes to exacerbate B. cenocepacia-induced lung epithelial inflammatory responses. In this study, we report that B. cenocepacia flagellin is glycosylated on at least 10 different sites with a single sugar, 4,6-dideoxy-4-(3-hydroxybutanoylamino)-D-glucose. We have identified key genes that are required for flagellin glycosylation, including a predicted glycosyltransferase gene that is linked to the flagellin biosynthesis cluster and a putative acetyltransferase gene located within the O-antigen lipopolysaccharide cluster. Another O-antigen cluster gene, rmlB, which is required for flagellin glycan and O-antigen biosynthesis, was essential for bacterial viability, uncovering a novel target against Burkholderia infections. Using glycosylated and nonglycosylated purified flagellin and a cell reporter system to assess TLR5-mediated responses, we also show that the presence of glycan in flagellin significantly impairs the inflammatory response of epithelial cells. We therefore suggest that flagellin glycosylation reduces recognition of flagellin by host TLR5, providing an evasive strategy to infecting bacteria.
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Affiliation(s)
- Anna Hanuszkiewicz
- From the Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast BT9 7AE, Ireland, United Kingdom
| | - Paula Pittock
- the Don Rix Protein Identification Facility, Department of Biochemistry, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Fiachra Humphries
- the Institute of Immunology, Department of Biology, National University of Ireland at Maynooth, Maynooth, County Kildare, Ireland
| | - Hermann Moll
- the Bioanalytical Chemistry, Research Centre Borstel, 23845 Borstel, Germany
| | - Amanda Roa Rosales
- the Department of Microbiology and Immunology, University of Western Ontario, London, Ontario N6A 5C1, Canada, and
| | - Antonio Molinaro
- the Dipartimento di Scienze Chimiche, Università di Napoli, Federico II, 80134 Naples, Italy
| | - Paul N Moynagh
- From the Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast BT9 7AE, Ireland, United Kingdom, the Institute of Immunology, Department of Biology, National University of Ireland at Maynooth, Maynooth, County Kildare, Ireland
| | - Gilles A Lajoie
- the Don Rix Protein Identification Facility, Department of Biochemistry, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Miguel A Valvano
- From the Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast BT9 7AE, Ireland, United Kingdom, the Department of Microbiology and Immunology, University of Western Ontario, London, Ontario N6A 5C1, Canada, and
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De Soyza A, Hall AJ, Mahenthiralingam E, Drevinek P, Kaca W, Drulis-Kawa Z, Stoitsova SR, Toth V, Coenye T, Zlosnik JEA, Burns JL, Sá-Correia I, De Vos D, Pirnay JP, Kidd TJ, Reid D, Manos J, Klockgether J, Wiehlmann L, Tümmler B, McClean S, Winstanley C. Developing an international Pseudomonas aeruginosa reference panel. Microbiologyopen 2013; 2:1010-23. [PMID: 24214409 PMCID: PMC3892346 DOI: 10.1002/mbo3.141] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/27/2013] [Accepted: 10/07/2013] [Indexed: 01/22/2023] Open
Abstract
Pseudomonas aeruginosa is a major opportunistic pathogen in cystic fibrosis (CF) patients and causes a wide range of infections among other susceptible populations. Its inherent resistance to many antimicrobials also makes it difficult to treat infections with this pathogen. Recent evidence has highlighted the diversity of this species, yet despite this, the majority of studies on virulence and pathogenesis focus on a small number of strains. There is a pressing need for a P. aeruginosa reference panel to harmonize and coordinate the collective efforts of the P. aeruginosa research community. We have collated a panel of 43 P. aeruginosa strains that reflects the organism's diversity. In addition to the commonly studied clones, this panel includes transmissible strains, sequential CF isolates, strains with specific virulence characteristics, and strains that represent serotype, genotype or geographic diversity. This focussed panel of P. aeruginosa isolates will help accelerate and consolidate the discovery of virulence determinants, improve our understanding of the pathogenesis of infections caused by this pathogen, and provide the community with a valuable resource for the testing of novel therapeutic agents.
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Affiliation(s)
- Anthony De Soyza
- Institute of Cellular Medicine, Newcastle University, Newcastle, U.K
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Van Acker H, Sass A, Bazzini S, De Roy K, Udine C, Messiaen T, Riccardi G, Boon N, Nelis HJ, Mahenthiralingam E, Coenye T. Biofilm-grown Burkholderia cepacia complex cells survive antibiotic treatment by avoiding production of reactive oxygen species. PLoS One 2013; 8:e58943. [PMID: 23516582 PMCID: PMC3596321 DOI: 10.1371/journal.pone.0058943] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 02/11/2013] [Indexed: 12/13/2022] Open
Abstract
The presence of persister cells has been proposed as a factor in biofilm resilience. In the present study we investigated whether persister cells are present in Burkholderia cepacia complex (Bcc) biofilms, what the molecular basis of antimicrobial tolerance in Bcc persisters is, and how persisters can be eradicated from Bcc biofilms. After treatment of Bcc biofilms with high concentrations of various antibiotics often a small subpopulation survived. To investigate the molecular mechanism of tolerance in this subpopulation, Burkholderia cenocepacia biofilms were treated with 1024 µg/ml of tobramycin. Using ROS-specific staining and flow cytometry, we showed that tobramycin increased ROS production in treated sessile cells. However, approximately 0.1% of all sessile cells survived the treatment. A transcriptome analysis showed that several genes from the tricarboxylic acid cycle and genes involved in the electron transport chain were downregulated. In contrast, genes from the glyoxylate shunt were upregulated. These data indicate that protection against ROS is important for the survival of persisters. To confirm this, we determined the number of persisters in biofilms formed by catalase mutants. The persister fraction in ΔkatA and ΔkatB biofilms was significantly reduced, confirming the role of ROS detoxification in persister survival. Pretreatment of B. cenocepacia biofilms with itaconate, an inhibitor of isocitrate lyase (ICL), the first enzyme in the glyoxylate shunt, reduced the persister fraction approx. 10-fold when the biofilms were subsequently treated with tobramycin. In conclusion, most Bcc biofilms contain a significant fraction of persisters that survive treatment with high doses of tobramycin. The surviving persister cells downregulate the TCA cycle to avoid production of ROS and at the same time activate an alternative pathway, the glyoxylate shunt. This pathway may present a novel target for combination therapy.
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Affiliation(s)
- Heleen Van Acker
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Andrea Sass
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Silvia Bazzini
- Dipartimento di Biologia e Biotecnologie “Lazzaro Spallanzani”, Università degli Studi di Pavia, Pavia, Italy
| | - Karen De Roy
- Laboratory of Microbial Ecology and Technology (LabMET), Ghent University, Gent, Belgium
| | - Claudia Udine
- Dipartimento di Biologia e Biotecnologie “Lazzaro Spallanzani”, Università degli Studi di Pavia, Pavia, Italy
| | - Thomas Messiaen
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Giovanna Riccardi
- Dipartimento di Biologia e Biotecnologie “Lazzaro Spallanzani”, Università degli Studi di Pavia, Pavia, Italy
| | - Nico Boon
- Laboratory of Microbial Ecology and Technology (LabMET), Ghent University, Gent, Belgium
| | - Hans J. Nelis
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Eshwar Mahenthiralingam
- Organisms and Environment Division Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
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Abstract
Lung transplantation is a well-established treatment option for selected patients with end-stage lung disease, leading to improved survival and improved quality of life. The last 20 years have seen a steady growth in number of lung transplantation procedures performed worldwide. The increase in clinical activity has been associated with tremendous progress in the understanding of cellular and molecular processes that limit both short- and long-term outcomes. This review gives a comprehensive overview of the current status of lung transplantation for the referring physician. It demonstrates that careful selection of potential recipients, optimisation of their condition prior to transplant, use of carefully assessed donor organs, excellent surgery and meticulous long-term follow-up are all essential ingredients in determining a successful outcome.
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Affiliation(s)
- Rahul Y Mahida
- Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne NHS Hospitals Foundation Trust, Newcast Upon Tyne, UK
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13
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Nicholson A, Perry JD, James AL, Stanforth SP, Carnell S, Wilkinson K, Anjam Khan C, De Soyza A, Gould FK. In vitro activity of S-(3,4-dichlorobenzyl)isothiourea hydrochloride and novel structurally related compounds against multidrug-resistant bacteria, including Pseudomonas aeruginosa and Burkholderia cepacia complex. Int J Antimicrob Agents 2012; 39:27-32. [DOI: 10.1016/j.ijantimicag.2011.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/22/2011] [Accepted: 08/24/2011] [Indexed: 10/16/2022]
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Román A, Ussetti P, Solé A, Zurbano F, Borro JM, Vaquero JM, de Pablo A, Morales P, Blanco M, Bravo C, Cifrian J, de la Torre M, Gámez P, Laporta R, Monforte V, Mons R, Salvatierra A, Santos F, Solé J, Varela A. Guidelines for the selection of lung transplantation candidates. Arch Bronconeumol 2011; 47:303-9. [PMID: 21536362 DOI: 10.1016/j.arbres.2011.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/26/2011] [Indexed: 01/24/2023]
Abstract
The present guidelines have been prepared with the consensus of at least one representative of each of the hospitals with lung transplantation programs in Spain. In addition, prior to their publication, these guidelines have been reviewed by a group of prominent reviewers who are recognized for their professional experience in the field of lung transplantation. Within the following pages, the reader will find the selection criteria for lung transplantation candidates, when and how to remit a patient to a transplantation center and, lastly, when to add the patient to the waiting list. A level of evidence has been identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider this treatment for their patients. Finally, these guidelines also propose an information form in order to compile in an organized manner the patient data of the potential candidate for lung transplantation, which are relevant in order to be able to make the best decisions possible.
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Affiliation(s)
- Antonio Román
- Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, España.
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15
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Hauser AR, Jain M, Bar-Meir M, McColley SA. Clinical significance of microbial infection and adaptation in cystic fibrosis. Clin Microbiol Rev 2011; 24:29-70. [PMID: 21233507 PMCID: PMC3021203 DOI: 10.1128/cmr.00036-10] [Citation(s) in RCA: 287] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.
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Affiliation(s)
- Alan R Hauser
- Department of Microbiology/Immunology, Northwestern University, 303 E. Chicago Ave., Searle 6-495, Chicago, IL 60611, USA.
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16
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De Soyza A, Meachery G, Hester KL, Nicholson A, Parry G, Tocewicz K, Pillay T, Clark S, Lordan JL, Schueler S, Fisher AJ, Dark JH, Gould FK, Corris PA. Lung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: A single-center experience. J Heart Lung Transplant 2010; 29:1395-404. [DOI: 10.1016/j.healun.2010.06.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 06/07/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022] Open
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17
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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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18
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Structural Elucidation of a NovelB. cenocepaciaET-12 Lipooligosaccharide Isolated from a Cystic Fibrosis Patient after Lung Transplantation. European J Org Chem 2010. [DOI: 10.1002/ejoc.200901200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Ierano T, Silipo A, Sturiale L, Garozzo D, Bryant C, Lanzetta R, Parrilli M, Aldridge C, Gould FK, Corris PA, Khan CMA, De Soyza A, Molinaro A. First structural characterization of Burkholderia vietnamiensis lipooligosaccharide from cystic fibrosis-associated lung transplantation strains. Glycobiology 2009; 19:1214-23. [DOI: 10.1093/glycob/cwp112] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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20
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Ieranò T, Silipo A, Cescutti P, Leone MR, Rizzo R, Lanzetta R, Parrilli M, Molinaro A. Structural Study and Conformational Behavior of the Two Different Lipopolysaccharide O-Antigens Produced by the Cystic Fibrosis PathogenBurkholderia multivorans. Chemistry 2009; 15:7156-66. [DOI: 10.1002/chem.200900647] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Church AC, Sivasothy P, Parmer J, Foweraker J. Mediastinal abscess after lung transplantation secondary to Burkholderia gladioli infection. J Heart Lung Transplant 2009; 28:511-4. [PMID: 19416783 DOI: 10.1016/j.healun.2009.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 01/13/2009] [Accepted: 01/22/2009] [Indexed: 01/08/2023] Open
Abstract
Burkholderia gladioli is an unusual organism that has become increasingly responsible for infections in patients who are immunosuppressed, including patients who have undergone solid organ transplantation. This article presents a patient in whom a mediastinal mass due to Burkholderia gladioli developed after lung transplantation. A review of the literature is also presented.
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Affiliation(s)
- Alistair C Church
- Department of Transplantation, Papworth Hospital, Papworth Everard, Cambridgeshire, UK
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22
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De Soyza A, Silipo A, Lanzetta R, Govan JR, Molinaro A. Chemical and biological features of Burkholderia cepacia complex lipopolysaccharides. Innate Immun 2008; 14:127-44. [PMID: 18562572 DOI: 10.1177/1753425908093984] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Burkholderia cepacia complex comprises 10 closely related Gram-negative organisms all of which appear capable of causing disease in humans. These organisms appear of particular relevance to patients with cystic fibrosis. Lipopolysaccharide (LPS) is an important virulence determinant in Gram-negative pathogens. In this review, we highlight important data within the field commenting on LPS/lipid A structure-to-function relationships and cytokine induction capacity of Burkholderia strains studied so far.
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Affiliation(s)
- Anthony De Soyza
- Transplantation and Immunobiology Group, Institute of Cellular Medicine, Newcastle University and The Freeman Hospital, Newcastle-upon-Tyne, UK.
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23
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Ieranò T, Silipo A, Sturiale L, Garozzo D, Brookes H, Khan CMA, Bryant C, Gould FK, Corris PA, Lanzetta R, Parrilli M, De Soyza A, Molinaro A. The structure and proinflammatory activity of the lipopolysaccharide from Burkholderia multivorans and the differences between clonal strains colonizing pre and posttransplanted lungs. Glycobiology 2008; 18:871-81. [DOI: 10.1093/glycob/cwn074] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Sweet SC, Aurora P, Benden C, Wong JY, Goldfarb SB, Elidemir O, Woo MS, Mallory GB. Lung transplantation and survival in children with cystic fibrosis: solid statistics--flawed interpretation. Pediatr Transplant 2008; 12:129-36. [PMID: 18307660 DOI: 10.1111/j.1399-3046.2008.00924.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In their provocative paper, "Lung transplantation and survival in children with cystic fibrosis," Liou and colleagues state that "Prolongation of life by means of lung transplantation should not be expected in children with cystic fibrosis. A prospective, randomized trial is needed to clarify whether and when patients derive a survival and quality of life benefit from lung transplantation." Unfortunately, that conclusion is not supportable. Liou's dataset introduced bias against transplantation by using covariates obtained well before the time of transplant (when predicted survival was good) and having a cohort with lower than expected post-transplant survival than reported elsewhere. The calculated hazard ratios are based on factors that may have changed between listing and transplant, and do not reflect true benefit on a patient by patient basis. The findings of the study are contrary to other studies using similar methods. Finally, recent changes in US lung transplant allocation policy may have made the study findings moot. In contrast to Liou's suggestion to perform an ethically and logistically challenging randomized trial to verify the benefit of lung transplantation, a research agenda is recommended for pediatric lung transplantation for cystic fibrosis that focuses on developing strategies to continually reassess and maximize quality of life and survival benefit.
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Affiliation(s)
- Stuart C Sweet
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA.
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25
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Mal H. Transplantation pulmonaire. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)92803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Sajjan US, Hershenson MB, Forstner JF, LiPuma JJ. Burkholderia cenocepacia ET12 strain activates TNFR1 signalling in cystic fibrosis airway epithelial cells. Cell Microbiol 2007; 10:188-201. [PMID: 17697131 PMCID: PMC3226749 DOI: 10.1111/j.1462-5822.2007.01029.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Burkholderia cenocepacia is an important pulmonary pathogen in individuals with cystic fibrosis (CF). Infection is often associated with severe pulmonary inflammation, and some patients develop a fatal necrotizing pneumonia and sepsis ('cepacia syndrome'). The mechanisms by which this species causes severe pulmonary inflammation are poorly understood. Here, we demonstrate that B. cenocepacia BC7, a potentially virulent representative of the epidemic ET12 lineage, binds to tumour necrosis factor receptor 1 (TNFR1) and activates TNFR1-related signalling pathway similar to TNF-alpha, a natural ligand for TNFR1. This interaction participates in stimulating a robust IL-8 production from CF airway epithelial cells. In contrast, BC45, a less virulent ET12 representative, and ATCC 25416, an environmental B. cepacia strain, do not bind to TNFR1 and stimulate only minimal IL-8 production from CF cells. Further, TNFR1 expression is increased in CF airway epithelial cells compared with non-CF cells. We also show that B. cenocepacia ET12 strain colocaizes with TNFR1 in vitro and in the lungs of CF patients who died due to infection with B. cenocepacia, ET12 strain. Together, these results suggest that interaction of B. cenocepacia, ET12 strain with TNFR1 may contribute to robust inflammatory responses elicited by this organism.
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Affiliation(s)
- Umadevi S Sajjan
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Drive, Ann Arbor, MI 48109, USA.
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27
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Silipo A, Molinaro A, Ieranò T, De Soyza A, Sturiale L, Garozzo D, Aldridge C, Corris PA, Khan CMA, Lanzetta R, Parrilli M. The complete structure and pro-inflammatory activity of the lipooligosaccharide of the highly epidemic and virulent gram-negative bacterium Burkholderia cenocepacia ET-12 (strain J2315). Chemistry 2007; 13:3501-11. [PMID: 17219455 DOI: 10.1002/chem.200601406] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Members of genus Burkholderia include opportunistic Gram-negative bacteria that are responsible for serious infections in immunocompromised and cystic fibrosis (CF) patients. The Burkholderia cepacia complex is a group of microorganisms composed of at least nine closely related genomovars. Among these, B. cenocepacia is widely recognized to cause epidemics associated with excessive mortality. Species that belong to this strain are problematic CF pathogens because of their high resistance to antibiotics, which makes respiratory infections difficult to treat and impossible to eradicate. Infection by these bacteria is associated with higher mortality in CF and poor outcomes following lung transplantation. One virulence factor contributing to this is the pro-inflammatory lipopolysaccharide (LPS) molecules. Thus, the knowledge of the lipopolysaccharide structure is an essential prerequisite to the understanding of the molecular mechanisms involved in the inflammatory process. Such data are instrumental in aiding the design of antimicrobial compounds and for developing therapeutic strategies against the inflammatory cascade. In particular, defining the structure of the LPS from B. cenocepacia ET-12 clone LMG 16656 (also known as J2315) is extremely important given the recent completion of the sequencing project at the Sanger Centre using this specific strain. In this paper we address this issue by defining the pro-inflammatory activity of the pure lipopolysaccharide, and by describing its full primary structure. The activity of the lipopolysaccharide was tested as a stimulant in human myelomonocytic U937 cells. The structural analysis was carried out by compositional analysis, mass spectrometry and 2D NMR spectroscopy on the intact lipooligosacchride (LOS) and its fragments, which were obtained by selective chemical degradations.
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Affiliation(s)
- Alba Silipo
- Dipartimento di Chimica Organica e Biochimica, Università di Napoli, Complesso Universitario Monte Sant'angelo, Via Cintia 4, 80126 Napoli, Italy
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28
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Slinger R, Yan L, Myers R, Ramotar K, St Denis M, Aaron SD. Pyrosequencing™ of a recA gene variable region for Burkholderia cepacia complex genomovar identification. Diagn Microbiol Infect Dis 2007; 58:379-84. [PMID: 17509790 DOI: 10.1016/j.diagmicrobio.2007.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 02/12/2007] [Accepted: 02/12/2007] [Indexed: 10/23/2022]
Abstract
We developed an assay to identify Burkholderia cepacia complex genomovars by Pyrosequencing of a variable recA gene segment. Fifteen reference strains and 30 clinical isolates of B. cepacia complex were sequenced. Full 77-base pair target sequences were obtained from 44 of the 45 isolates, and BLAST queries of the sequences correctly identified the genomovar of these 44 isolates. Three Burkholderia multivorans isolates were identified as B. multivorans/Burkholderia ambifaria, indicating that additional identification methods may be needed for some B. multivorans strains.
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Affiliation(s)
- Robert Slinger
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada K1H 8MS.
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29
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Turton JF, Arif N, Hennessy D, Kaufmann ME, Pitt TL. Revised approach for identification of isolates within the Burkholderia cepacia complex and description of clinical isolates not assigned to any of the known genomovars. J Clin Microbiol 2007; 45:3105-8. [PMID: 17626169 PMCID: PMC2045300 DOI: 10.1128/jcm.00976-07] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
One hundred thirty-eight clinical isolates of the Burkholderia cepacia complex (Bcc) were identified using a modified strategy that involved PCR detection of the cblA gene for the ET12 lineage simultaneously with detection of the Bcc recA PCR product; recA sequence cluster analysis also was part of the strategy. Four strains could not be assigned to any of the known genomovars.
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Affiliation(s)
- Jane F Turton
- Laboratory of HealthCare Associated Infection, Centre for Infections, Health Protection Agency, 61 Colindale Ave., London NW9 5EQ, United Kingdom.
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30
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Abstract
Transplantation in patients who have cystic fibrosis (CF) presents important challenges regarding candidate selection and preoperative management, technical obstacles in the perioperative period, the postoperative management of medical comorbidities related to CF, and the psychosocial impact of transplantation. This article outlines some of these challenges and describes recent advances in approaching this endeavor in patients who have CF.
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Affiliation(s)
- Hilary J Goldberg
- Department of Medicine, Harvard Medical School, PBB Clinics-3, 75 Francis Street, Boston, MA 02115, USA.
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31
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Govan JRW, Brown AR, Jones AM. Evolving epidemiology of Pseudomonas aeruginosa and the Burkholderia cepacia complex in cystic fibrosis lung infection. Future Microbiol 2007; 2:153-64. [PMID: 17661652 DOI: 10.2217/17460913.2.2.153] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The morbidity and mortality of patients with cystic fibrosis (CF) is primarily determined by chronic and debilitating lung infections caused by a surprisingly narrow spectrum of bacterial pathogens. Pseudomonas aeruginosa is by far the most prevalent life-threatening CF pathogen. In the absence of aggressive early therapy, it infects the majority of adult patients and determines long-term survival. The epidemiology of CF pulmonary infections continues to evolve. Amongst the most recent CF pathogens to have emerged are a group of closely related bacteria, known as the Burkholderia cepacia complex. These organisms are a particular challenge due to inherent antibiotic resistance, the potential for patient-to-patient spread, and the risk of ‘cepacia syndrome’, a rapid fulminating pneumonia sometimes accompanied by bacteremia. Strict cross-infection control was prompted by early epidemiological experience of the B. cepacia complex and is essential in the management of all CF pathogens.
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Affiliation(s)
- John R W Govan
- University of Edinburgh, Cystic Fibrosis Group, Centre for Infectious Diseases, Edinburgh, UK.
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32
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Waters V, Ratjen F. Multidrug-resistant organisms in cystic fibrosis: management and infection-control issues. Expert Rev Anti Infect Ther 2007; 4:807-19. [PMID: 17140357 DOI: 10.1586/14787210.4.5.807] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic infection and inflammation are the hallmarks of cystic fibrosis lung disease. As cystic fibrosis patients are living longer owing to more intense treatment, multidrug-resistant organisms are being isolated increasingly from patients' respiratory tracts. While the adverse effects of Pseudomonas aeruginosa and Burkholderia cepacia complex are well described, less is known about the clinical significance of other emerging multidrug-resistant organisms, such as methicillin-resistant Staphylococcus aureus and Stenotrophomonas maltophilia. Owing to multiple mechanisms of antimicrobial resistance, these organisms are difficult to treat and often require combination antibiotic therapy. Until more is known about their pathogenicity and effect on clinical outcomes, physicians should be aware of the potential transmissibility of these organisms and implement adequate infection control strategies.
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Affiliation(s)
- Valerie Waters
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
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33
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Affiliation(s)
- J S Elborn
- Respiratory Medicine Group, Queens' University of Belfast, Belfast, N. Ireland.
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34
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Vanlaere E, Hansraj F, Vandamme PAR, Govan JRW. Growth in Stewart's medium is a simple, rapid and inexpensive screening tool for the identification of Burkholderia cepacia complex. J Cyst Fibros 2006; 5:137-9. [PMID: 16386966 DOI: 10.1016/j.jcf.2005.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 10/27/2005] [Accepted: 11/22/2005] [Indexed: 10/25/2022]
Abstract
Ninety-one percent of Burkholderia cepacia complex reference strains (66 out of 72) displayed a yellow slope-green butt colour reaction after growth in Stewart's medium indicating the oxidation of glucose and the absence of an arginine dihydrolase system. This same colour reaction was observed for Burkholderia gladioli and several Ralstonia species, but not for Pseudomonas aeruginosa, Stenotrophomonas, Achromobacter, Pandoraea and several other Gram-negative non-fermenting bacilli. We therefore consider growth in Stewart's medium a useful, simple, rapid and inexpensive screening test to reduce the number of false positive isolates from B. cepacia complex selective media.
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Affiliation(s)
- Elke Vanlaere
- Laboratory of Microbiology, Gent University, 9000 Gent, Belgium
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35
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Seed KD, Dennis JJ. Isolation and characterization of bacteriophages of the Burkholderia cepacia complex. FEMS Microbiol Lett 2006; 251:273-80. [PMID: 16140471 DOI: 10.1016/j.femsle.2005.08.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 08/08/2005] [Accepted: 08/09/2005] [Indexed: 11/22/2022] Open
Abstract
The Burkholderia cepacia complex consists of nine phenotypically similar but genotypically distinct beta-proteobacteria that are metabolically diverse and highly antibiotic resistant. Because of this exceptional intrinsic antibiotic resistance, infections with B. cepacia complex members are difficult to treat clinically and new alternative therapies are required. One strategy that holds some promise is the use of naturally occurring antibacterial bacteriophages that could potentially bind to and lyse B. cepacia complex cells in vivo. Towards that end, we used enrichment techniques to isolate lytic and lysogenic bacteriophages specific to the B. cepacia complex. The newly isolated bacteriophages were characterized by host range analysis, electron microscopy, genome restriction analysis, and partial DNA sequencing. These isolates include a bacteriophage with one of the broadest host ranges yet identified for any bacteriophage specific to the B. cepacia complex, and the first description of bacteriophages capable of lysing B. ambifaria.
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Affiliation(s)
- Kimberley D Seed
- Department of Biological Sciences, University of Alberta, Edmonton, Alta., Canada T6G 2E9
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36
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Campana S, Taccetti G, Ravenni N, Favari F, Cariani L, Sciacca A, Savoia D, Collura A, Fiscarelli E, De Intinis G, Busetti M, Cipolloni A, d'Aprile A, Provenzano E, Collebrusco I, Frontini P, Stassi G, Trancassini M, Tovagliari D, Lavitola A, Doherty CJ, Coenye T, Govan JRW, Vandamme P. Transmission of Burkholderia cepacia complex: evidence for new epidemic clones infecting cystic fibrosis patients in Italy. J Clin Microbiol 2005; 43:5136-42. [PMID: 16207975 PMCID: PMC1248445 DOI: 10.1128/jcm.43.10.5136-5142.2005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To analyze national prevalence, genomovar distribution, and epidemiology of the Burkholderia cepacia complex in Italy, 225 putative B. cepacia complex isolates were obtained from 225 cystic fibrosis (CF) patients attending 18 CF centers. The genomovar status of these isolates was determined by a polyphasic approach, which included whole-cell protein electrophoresis and recA restriction fragment length polymorphism (RFLP) analysis. Two approaches were used to genotype B. cepacia complex isolates: BOX-PCR fingerprinting and pulsed-field gel electrophoresis (PFGE) of genomic macrorestriction fragments. A total of 208 (92%) of 225 isolates belonged to the B. cepacia complex, with Burkholderia cenocepacia as the most prevalent species (61.1%). Clones delineated by PFGE were predominantly linked to a single center; in contrast, BOX-PCR clones were composed of isolates collected either from the same center or from different CF centers and comprised multiple PFGE clusters. Three BOX-PCR clones appeared of special interest. One clone was composed of 17 B. cenocepacia isolates belonging to recA RFLP type H. These isolates were collected from six centers and represented three PFGE clusters. The presence of insertion sequence IS 1363 in all isolates and the comparison with PHDC reference isolates identified this clone as PHDC, an epidemic clone prominent in North American CF patients. The second clone included 22 isolates from eight centers and belonged to recA RFLP type AT. The genomovar status of strains with the latter RFLP type is not known. Most of these isolates belonged to four different PFGE clusters. Finally, a third clone comprised nine B. pyrrocinia isolates belonging to recA RFLP type Se 13. They represented three PFGE clusters and were collected in three CF centers.
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Affiliation(s)
- S Campana
- Department of Pediatrics, Cystic Fibrosis Center, University of Florence, 50132 Florence, Italy.
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37
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Abstract
PURPOSE OF REVIEW The Burkholderia cepacia complex is comprised of a group of related bacterial species that are capable of causing life-threatening respiratory tract infection in persons with cystic fibrosis. This article reviews advances in our understanding of Burkholderia cepacia complex infection in cystic fibrosis, focusing on the taxonomy, clinical microbiology, and epidemiology, as well as the natural history and clinical outcomes associated with Burkholderia cepacia complex infection. RECENT FINDINGS Each of the nine species of the Burkholderia cepacia complex has now received a formal species name. These names are the preferred nomenclature, replacing the former 'genomovar' designations. Studies from several countries reiterate that two species, Burkholderia cenocepacia and Burkholderia multivorans, account for most Burkholderia cepacia complex infection in cystic fibrosis. Bacterial genotyping studies indicate that specific Burkholderia cepacia complex strains infect multiple cystic fibrosis patients, implying that they may have an enhanced capacity for interpatient spread. Emerging clinical outcomes data suggest that at least some of these so-called transmissible or epidemic strains are also more virulent in the cystic fibrosis host. Ongoing research is aimed at gaining a better understanding of Burkholderia cepacia complex ecology, defining Burkholderia cepacia complex virulence factors and pathogenic mechanisms, and determining the relative virulence of distinct strains. SUMMARY Significant advances in our understanding of the Burkholderia cepacia complex serve as a critical foundation for further efforts that ultimately will enable better infection control and the development of novel therapeutics to treat Burkholderia cepacia complex infection in persons with cystic fibrosis.
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Affiliation(s)
- John J Lipuma
- Division of Infectious Diseases, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan 48109-0646, USA.
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