A case of pan‐resistant <i>Burkholderia cepacia complex</i> bacteremic pneumonia, after lung transplantation treated with a targeted combination therapy

Cantón-Bulnes, María Luisa; Martínez, Ángela Hurtado; López-Cerero, Lorena; Seisdedos, Ángel Arenzana; Merino-Bohórquez, Vicente; Garnacho-Montero, José

doi:10.1111/tid.13034

Cited by 17 publications

(11 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, alternative decolonization strategies are emerging in the perioperative period of a LTx. Indeed, different solutions have been tested with interesting results, such as perioperative tracheobronchial lavage and/or pleural irrigation with antiseptic solutions [34,35] or a combination of antibiotic therapies [36,37].…”

Section: Discussionmentioning

confidence: 99%

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

et al. 2020

View full text Add to dashboard Cite

Background: Infection is the most common cause of mortality within the first year after lung transplantation (LTx). The management of perioperative antibiotic therapy is a major issue, but little is known about worldwide practices. Methods: We sent by email a survey dealing with 5 daily clinical vignettes concerning perioperative antibiotic therapy to 180 LTx centers around the world. The invitation and a weekly reminder were sent to lung transplant specialists for a single consensus answer per center during a 3-month period. Results: We received a total of 99 responses from 24 countries, mostly from Western Europe (n = 46) and the USA (n = 34). Systematic screening for bronchial recipient colonization before LTx was mostly performed with sputum samples (72%), regardless of the underlying lung disease. In recipients without colonization, antibiotics with activity against gram-negative bacteria resistant strains (piperacillin / tazobactam, cefepime, ceftazidime, carbapenems) were reported in 72% of the centers, and antibiotics with activity against methicillin-resistant Staphylococcus aureus (mainly vancomycin) were reported in 38% of the centers. For these recipients, the duration of antibiotics reported was 7 days (33%) or less (26%) or stopped when cultures of donor and recipients were reported negatives (12%). In recipients with previous colonization, antibiotics were adapted to the susceptibility of the most resistant strain and given for at least 14 days (67%). Conclusion: Practices vary widely around the world, but resistant bacterial strains are mostly targeted even if no colonization occurs. The antibiotic duration reported was longer for colonized recipients.

show abstract

Section: Discussionmentioning

confidence: 99%

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Several case reports described the favorable clinical response to a CAZ-AVI-containing regimen in the treatment of infections caused by B. cepacia complex. These include one case report in a 2-month-old infant with B. cepacia bacteremia (99) and several cases of lung transplant and cystic fibrosis patients with B. cepacia serious infections (100)(101)(102)(103)(104). In an in vitro study, CAZ-AVI was demonstrated to have greater activity specifically against Burkholderia multivorans than ceftazidime (MIC 90 values of 4 and 16 mg/liter, respectively).…”

Section: Clinical Datamentioning

confidence: 99%

New β-Lactam–β-Lactamase Inhibitor Combinations

et al. 2020

View full text Add to dashboard Cite

SUMMARY The limited armamentarium against drug-resistant Gram-negative bacilli has led to the development of several novel β-lactam–β-lactamase inhibitor combinations (BLBLIs). In this review, we summarize their spectrum of in vitro activities, mechanisms of resistance, and pharmacokinetic-pharmacodynamic (PK-PD) characteristics. A summary of available clinical data is provided per drug. Four approved BLBLIs are discussed in detail. All are options for treating multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa. Ceftazidime-avibactam is a potential drug for treating Enterobacterales producing extended-spectrum β-lactamase (ESBL), Klebsiella pneumoniae carbapenemase (KPC), AmpC, and some class D β-lactamases (OXA-48) in addition to carbapenem-resistant Pseudomonas aeruginosa. Ceftolozane-tazobactam is a treatment option mainly for carbapenem-resistant P. aeruginosa (non-carbapenemase producing), with some activity against ESBL-producing Enterobacterales. Meropenem-vaborbactam has emerged as treatment option for Enterobacterales producing ESBL, KPC, or AmpC, with similar activity as meropenem against P. aeruginosa. Imipenem-relebactam has documented activity against Enterobacterales producing ESBL, KPC, and AmpC, with the combination having some additional activity against P. aeruginosa relative to imipenem. None of these drugs present in vitro activity against Enterobacterales or P. aeruginosa producing metallo-β-lactamase (MBL) or against carbapenemase-producing Acinetobacter baumannii. Clinical data regarding the use of these drugs to treat MDR bacteria are limited and rely mostly on nonrandomized studies. An overview on eight BLBLIs in development is also provided. These drugs provide various levels of in vitro coverage of carbapenem-resistant Enterobacterales, with several drugs presenting in vitro activity against MBLs (cefepime-zidebactam, aztreonam-avibactam, meropenem-nacubactam, and cefepime-taniborbactam). Among these drugs, some also present in vitro activity against carbapenem-resistant P. aeruginosa (cefepime-zidebactam and cefepime-taniborbactam) and A. baumannii (cefepime-zidebactam and sulbactam-durlobactam).

show abstract

“…Among these combinations, colistin and ceftazidime-avibactam with or without ceftolozane-tazobactam have been reported successful for BCC even with disseminated disease. 69,[93][94][95] The rationale for using avibactam is that it restores susceptibility to ceftazidime for BCC isolates. 96 Precise surgical techniques have been described especially for B. cenocepacia and include irrigation of the chest cavity and bronchi with 0.5% povidone-iodine solution or taurolidine.…”

Section: Pseudomonas and Burkholderia: Therapeutic Optionsmentioning

confidence: 99%

“…They include such diverse options as bilateral pneumonectomy and ECMO pre-LTX in a patient with sepsis, a study of antibiotic perfusion of explanted lungs in a porcine model and less common antibiotic combinations based on in vitro studies of multiple antibiotic bactericidal testing, and last but not least, bacteriophage therapy which seems to hold a degree of promise. 93,94,96,[98][99][100][101][102][103][104][105] As mentioned earlier, a systematic approach has recently been described but is yet to be validated and widely adopted. 8 Pseudomonas and Burkholderia: Lung Transplant Outcomes-Morbidity, Mortality, Societal Cost Single lung transplantation (SLTx) allows the study of the differences between native and allograft lungs.…”

Section: Pseudomonas and Burkholderia: Therapeutic Optionsmentioning

confidence: 99%

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes

Mitchell

Glanville

2021

Semin Respir Crit Care Med

View full text Add to dashboard Cite

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.

show abstract

A case of pan‐resistant Burkholderia cepacia complex bacteremic pneumonia, after lung transplantation treated with a targeted combination therapy

Cited by 17 publications

References 13 publications

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation

New β-Lactam–β-Lactamase Inhibitor Combinations

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes

Contact Info

Product

Resources

About