Implementation of a successful eradication protocol for Burkholderia Cepacia complex in cystic fibrosis patients

Abstract

BackgroundInfection with Burkholderia cepacia complex (Bcc) results in a heterogeneous clinical course ranging from asymptomatic colonization of the airways to fulminant respiratory failure in patients with cystic fibrosis (CF). Early eradication of Pseudomonas aeruginosa improves clinical outcomes. The efficacy and clinical outcomes following implementation of an eradication protocol for Bcc are less well understood.MethodsWe developed and implemented a single center Bcc eradication protocol that included an intensive combination of intravenous, inhaled, and oral antibiotic therapies based on in vitro sensitivities. We conducted a retrospective cohort analysis of clinical outcomes compared to patients with chronic Bcc infection.ResultsSix patients were identified as having a newly acquired Bcc colonization and were placed on the eradication protocol. Sequential sputum samples after completion of the protocol demonstrated sustained clearance of Bcc in all patients. Lung function and nutritional status remained stable in the year following eradication.ConclusionClearance of Bcc from sputum cultures using a standardized protocol was successful at one year and was associated with clinical stability.

Management of initial colonisations with Burkholderia species in France, a retrospective analysis in five Cystic Fibrosis Centres

“…In children, trimethoprimsulfamethoxazole represents an alternative to quinolones. Based on our study and previous observations, IV/ PO treatments could be administered during 2 to 3 weeks whereas longer durations (8 to 12 weeks) could be proposed for inhaled treatments [26,33]. Due to the heterogeneity of the population of CF patients, clinical trials assessing different treatment protocols will probably be required to determine management algorithms taking into account all clinical and microbiological situations (extent of pulmonary involvement, Burkholderia species, co-pathogens).…”

“…Such heterogeneity was also reported in the UK survey by Horsley et al [26], and within published studies. cetazidime, trimethoprim-sulfamethoxazole) and a 2 months consolidation stage (trimethoprimsulfamethoxazole, inhaled tobramycin), combined with long-term azithromycin as anti-inflammatory [33]. However, due to the low numbers of patients and the diversity of patient populations and treatment protocols, the best antibiotic strategy is not defined to date [18].…”

RefractoryBurkholderia cepaciabacteraemia from a consolidation pneumonia lasting more than 7 weeks, successfully treated with systemic antibiotics and nebulised meropenem

“…In a small retrospective single-centre study, combination of intravenous, inhaled and oral antibiotics resulted to sustained clearance of BCC from sputum cultures and clinical stability at 1 year among six CF patients with newly acquired BCC colonisation. The eradication protocol involved a 21-day induction period composed of intravenous tobramycin and ceftazidime, oral TMP-SMX and azithromycin, and nebulised tobramycin; and a 2-month consolidation period of oral TMP-SMX and azithromycin and nebulised tobramycin 30. The use of combination antimicrobial for BCC exhibited synergistic action: tobramycin+ceftazidime (35.4% synergy), meropenem+tobramycin (32.3%) and levofloxacin+piperacillin tazobactam (22.2%) 31.…”

Management of initial colonisations with Burkholderia species in France, with retrospective analysis in five Cystic Fibrosis Centres: a pilot study.

“…Such heterogeneity was also reported in the UK survey by Horsley et al [26], and within published studies. Kitt et al successfully proposed tobramycin, temocillin and ceftazidime IV combination therapy for 14 days followed by a switch to tobramycin aerosols for 3 months in 2 children ( [33]. However, due to the low numbers of patients and the diversity of patient populations and treatment protocols, the best antibiotic strategy is not defined to date [18].…”

“…In children, trimethoprim-sulfamethoxazole represents an alternative to quinolones. IV/ PO treatments could be administered during 2 to 3 weeks whereas longer durations (8 to 12 weeks) could be proposed for inhaled treatments [26,33]. Lastly, given the specific pharmacodynamic profile of CF subjects, antibiotic assays should be encouraged for the purpose of dose optimisation.…”