Clinical characteristics of bacteraemia caused by Burkholderia cepacia complex species and antimicrobial susceptibility of the isolates in a medical centre in Taiwan

Chien, Ying-Chun; Liao, Chun-Hsing; Sheng, Wang‐Huei; Chien, Jung-Yien; Huang, Yu-Tsung; Yu, Chong‐Jen; Hsueh, Po-Ren

doi:10.1016/j.ijantimicag.2017.07.004

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…Unexpectedly, despite the high mortality rate, BC infection did not show obvious resistance to a variety of commonly used antibiotics, which is similar to the results of multiple previous studies [ 30 , 31 ]. We speculate that this may be related to the improper selection of antibiotics during empiric anti-infective therapy.…”

Section: Discussionsupporting

confidence: 89%

Clinical characteristics, drug resistance and death risk factors of Burkholderia cepacia infection in hematopoietic stem cell transplant patients

Jia

Liu

et al. 2022

BMC Infect Dis

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Background Burkholderia cepacia (BC) has been detected more and more in infected patients in recent years. However, as a high-risk population, the clinical characteristics and prognosis of BC infection in hematopoietic stem cell transplantation (HSCT) patients have not been reported. The purpose of this study is to obtain data that will help fill in the gaps in this field, provide evidence for reducing the mortality rate of BC infection in HSCT patients, and guide the use of antibiotics in the future. Methods Electronic medical records of patients with BC infection who underwent HSCT in Xiangya Hospital of Central South University from September 1, 2015 to August 31, 2021 were collected. At the same time, 1:1 case–control matching was conducted according to gender, age and disease type. Comparisons between patients with/without BC infection and respiratory failure were made respectively, and the sensitivity of BC to five clinically commonly used antibiotics was also evaluated. Univariate and multivariate analyses were performed to identify independent risk factors for death. Results The most common site of BC infection in HSCT patients was the lung (75%). Although BC infection rate (3.74%) and antibiotic resistance were not significant, it was closely associated with a higher risk of death (P = 0.022), which even further increased to 90.9% when combined with respiratory failure (P = 0.008). Procalcitonin > 10 µg/L (HR = 40.88, 95% CI 6.51–256.63, P = 0.000) and septic shock (HR = 4.08, 95% CI 1.02–16.33, P = 0.047) were two independent risk factors for death. Conclusion HSCT patients with BC infection are in critical condition, and the management of respiratory infection should be especially strengthened to improve the prognosis of these patients.

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Section: Discussionsupporting

confidence: 89%

Clinical characteristics, drug resistance and death risk factors of Burkholderia cepacia infection in hematopoietic stem cell transplant patients

Jia

Liu

et al. 2022

BMC Infect Dis

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“…The main mechanism of B. cepacia resistance to meropenem involves overexpression of class A β-lactamase caused by mutations in the penA gene located on chromosome 2, and mutation or modification of this gene by key amino acid residues reduces the susceptibility of B. cepacia to cephalosporins and meropenem. 22 , 23 Our research showed that the resistance rate to meropenem was 7.42%, which was lower than the 22.2–52% reported in other regions, 17 , 18 , 24 suggesting that meropenem should be considered for the empirical treatment of bloodstream infections caused by B. cepacia in Hebei province, China. Comparing the bacterial resistance rates among departments showed that the rate of levofloxacin-resistant isolates was significantly higher in the ICU compared with the medical and surgical departments (P<0.05).…”

Section: Discussioncontrasting

confidence: 57%

“…B. cepacia -related bloodstream infections are difficult to treat, and the mortality rate varies from 16%–53.8%. 3 , 12 , 17 , 18 This may be related to the limited choice of clinical drugs due to the specific drug-resistance phenotype. B. cepacia is naturally resistant to most β-lactam antibiotics, as well as aminoglycosides and colistin antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Investigation of Drug-Resistance in Burkholderia Cepacia Bloodstream Infections in Hebei Province, China, from 2016 to 2021

Liu,

Li,

Wen

et al. 2024

IDR

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Objective To compare the epidemiological characteristics and drug resistance of Burkholderia cepacia isolated from blood cultures, and to provide data support and a scientific basis for the clinical treatment and detection of hospital infections. Methods The Hebei Province Antimicrobial Surveillance Network received 349 B. cepacia strains isolated from blood cultures reported by 83 hospitals, from 2016 to 2021. These strains were identified by MALDI-TOF MS and, the antibiotic sensitivity tests were carried out using the VITEK 2 COMPACT system. The 2023 Institute of Clinical and Laboratory Standardization drug-susceptibility breakpoints were used for drug susceptibility testing and the data were analyzed using WHONET5.6 software. Results A total of 349 B. cepacia strains were isolated from 2016 to 2021, including 68 strains from secondary hospitals and 281 strains from tertiary hospitals. The ratios of male: female patients with B. cepacia bloodstream infections in all hospitals, secondary hospitals, and tertiary hospitals were 1.49:1 (209/140), 2.09:1 (46/22), and 1.38:1 (163/118), respectively. Most B. cepacia strains were isolated in intensive care units (ICUs), followed by internal medicine departments, accounting for 49.57% (173/349) and 22.92% (80/349), respectively. Regarding the age distribution, most patients were elderly (>65 years, 57.59%, 201/349), with numbers of patients gradually declining with decreasing of age. The resistance rates for levofloxacin, ceftazidime, and sulfamethoxazole decreased over the 6-year period (P<0.05), while there were no significant changes in the resistance rates for meropenem, chloramphenicol, and minocycline (P>0.05). There was no significant difference in drug-resistance rates between secondary and tertiary hospitals (P>0.05). Conclusion Attention should be paid to bloodstream infections caused by B. cepacia , especially elderly patients and patients admitted to the ICU. The difficult treatment characteristics of B. cepacia bloodstream infections mean that laboratories and clinicians should pay careful attention to drug resistance to provide a basis for their prevention and empirical treatment.

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“…BCC tend to localize within macrophages, which may contribute to discordance between treatment response and in vitro susceptibility [ 75 ]. Resistance to aminoglycosides, fluoroquinolones, sulfamethoxazole-trimethoprim (SMX-TMP), ceftazidime, and meropenem necessitates combination therapy, including ceftazidime-avibactam [ 46 ••, 77 ]. Local epidemiology varies, with incidence of BCC in Canadian centers being higher than in the USA (7.2% vs. 4.5%) [ 75 ].…”

Section: Epidemiology and Risk Factors Of Antimicrobial Resistance In...mentioning

confidence: 99%

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

Walti

2022

Curr Infect Dis Rep

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Purpose of Review Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae , are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.

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Clinical characteristics of bacteraemia caused by Burkholderia cepacia complex species and antimicrobial susceptibility of the isolates in a medical centre in Taiwan

Cited by 13 publications

References 32 publications

Clinical characteristics, drug resistance and death risk factors of Burkholderia cepacia infection in hematopoietic stem cell transplant patients

Clinical characteristics, drug resistance and death risk factors of Burkholderia cepacia infection in hematopoietic stem cell transplant patients

Multicenter Investigation of Drug-Resistance in Burkholderia Cepacia Bloodstream Infections in Hebei Province, China, from 2016 to 2021

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

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