Accurate identification and epidemiological characterization of Burkholderia cepacia complex: an update

Abstract

Bacteria belonging to the Burkholderia cepacia complex (Bcc) are among the most important pathogens isolated from cystic fibrosis (CF) patients and in hospital acquired infections (HAI). Accurate identification of Bcc is questionable by conventional biochemical methods. Clonal typing of Burkholderia is also limited due to the problem with identification. Phenotypic identification methods such as VITEK2, protein signature identification methods like VITEK MS, Bruker Biotyper, and molecular targets such as 16S rRNA, recA, hisA and rpsU were reported with varying level of discrimination to identify Bcc. rpsU and/or 16S rRNA sequencing, VITEK2, VITEK MS and Bruker Biotyper could discriminate between Burkholderia spp. and non-Burkholderia spp. Whereas, Bcc complex level identification can be given by VITEK MS, Bruker Biotyper, and 16S rRNA/rpsU/recA/hisA sequencing. For species level identification within Bcc hisA or recA sequencing are reliable. Identification of Bcc is indispensable in CF patients and HAI to ensure appropriate antimicrobial therapy.

An Overview of the Treatment of Less Common Non–Lactose‐Fermenting Gram‐Negative Bacteria

“…The 30-day mortality rate was 23% and, interestingly, did not differ based on the appropriateness of empiric antibiotics. 64 Due to limited clinical treatment data, literature analyzing in vitro susceptibilities of Achromobacter and Alcaligenes suggests that piperacillin-tazobactam, carbapenems, ceftazidime, or trimethoprim- Trimethoprim-sulfamethoxazole Minocycline Levofloxacin Tigecycline Ceftazidime-avibactam + aztreonam Amoxicillin-clavulanate + aztreonam Burkholderia cepacia complex 2,17,[19][20][21][22][23][24][25][26] Trimethoprim-sulfamethoxazole Meropenem Ceftazidime Minocycline Ceftazidime-avibactam Ceftazidime-avibactam + piperacillin-tazobactam Elizabethkingia spp. 27,30,[35][36][37][38] Combination of any of the below: Minocycline Moxifloxacin, levofloxacin Rifampin Piperacillin-tazobactam Trimethoprim-sulfamethoxazole…”

“…BCC was first described as a cause of onion rot in 1949 by Walter H. Burkholder, a plant pathologist. 22 Initially named Pseudomonas cepacia, the BCC genus now includes more than 20 species. Although traditionally thought to be primarily plant pathogens, bacteria belonging to the genus have since been identified as important opportunistic pathogens, particularly among those with cystic fibrosis, chronic granulomatous disease, and the immunocompromised.…”

“…Additionally, an outbreak of BCC bacteremia in 2016 was caused by contaminated liquid docusate. 22,23 Other less common rare manifestations of BCC infection include septic arthritis, urinary tract infections, and disseminated skin lesions.…”

A Phylogeny-Informed Proteomics Approach for Species Identification within the Burkholderia cepacia Complex

“…Automatic call rules for individual peptides were then applied as described (23). MALDI-TOF mass spectrometry is now used routinely in hospital microbiology laboratories for rapid identification of many other bacterial pathogens, but commercial MALDI-TOF MS approaches, in which identification is based in part on conserved ribosomal and heat shock proteins, have difficulty differentiating species within the Bcc, similar to marker genebased methods (13,23,24). Methods that take into account recombination are best suited to guide selection of optimal genetic markers for diagnostic assay development.…”

“…A widely used scheme is based on seven markers typically including recA, gyrB, and rpoB that can be used in conjunction with 16S rRNA sequences (22). Such schemata, however, can provide inconsistent species determinations, with consequences for diagnostic classification of clinical isolates (23).…”