Burkholderia cepacia complex Cervical Osteomyelitis in an Intravenous Drug User

Burkholderia cepacia Complex Lumbar Spondylodiscitis: A Rare Nosocomial Infection

Pyogenic spondylodiscitis is rarely caused by Burkholderia cepacia complex. B. cepacia is widespread in the environment and recognized as an opportunistic pathogen for patients with cystic fibrosis and immune disorders. A female in her mid-30s with underlying hyperthyroidism, but otherwise immunocompetent, was admitted to the hospital with persistent lower back pain after elective bariatric surgery in Mexico. Lumbar MRI showed L2/L3 osteomyelitis and discitis. Culture of disk aspiration grew Burkholderia cepacia complex sensitive to cefepime, ceftazidime, ciprofloxacin, gentamicin, imipenem, levofloxacin, and trimethoprim-sulfamethoxazole. The infection failed to respond to cefepime; however, she was successfully treated with levofloxacin monotherapy.

Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016-2019

During March 2016–January 2019, Burkholderia cepacia complex (BCC) infection developed in 13 persons who inject drugs (PWID) in Kowloon West Region, Hong Kong, China. Seven cases were infective spondylitis, 2 endocarditis, 2 septic arthritis, 1 intramuscular abscess and bacteremia, and 1 necrotizing fasciitis. Pulsed-field gel electrophoresis revealed that the isolates from 9 patients were clonally related. This clone caused major illness, and 11 of the 13 patients required surgical treatment. Clinicians should be aware of this pathogen and the appropriate broad-spectrum antimicrobial drugs to empirically prescribe for PWID with this life-threatening infection. Close collaboration among public health authorities, outreach social workers, and methadone clinics is essential for timely prevention and control of outbreaks in the PWID population.

Burkholderia cepacia complex infection complicating long-term urethral catheterisation

This report describes a 79-year-old Caucasian man with a history of syringomyelia, paraplegia and a long-term urethral catheter, presenting with recurrent catheter-related or catheter-associated urinary tract infections (CAUTIs) and persistent delirium. On one occasion, urine cultured bacteria from the Burkholderia cepacia complex (BCC). This organism is recognised as being a coloniser of fluid or aquatic settings. However, in certain circumstances (eg, immunosuppression, immunocompromise, multimorbidity), BCC has been recognised to cause infection, that is, rather than merely contamination or colonisation. In this unwell older patient, treatment of the BCC CAUTI was guided by antibiotic sensitivities and microbiology advice. The report incorporates a brief discussion of some relevant microbiological terminology, and refers to associations and commoner sites of BCC-related infection. The report concludes by exploring how three philosophical concepts (Occam's razor, Hickam's dictum and Crabtree's bludgeon) proved relevant in supporting clinical decision-making in this case.