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

Abstract

Background: Whereas Burkholderia infections are recognized to impair prognosis in cystic fibrosis (CF) patients, there is no recommendation to date for early eradication therapy. The aim of our study was to analyse the current management of initial colonisations with Burkholderia cepacia complex (BCC) or B. gladioli in French CF Centres and its impact on bacterial clearance and clinical outcome. Methods: We performed a retrospective review of the primary colonisations (PC), defined as newly positive sputum cultures, observed between 2010 and 2018 in five CF Centres. Treatment regimens, microbiological and clinical data were collected. Results: Seventeen patients (14 with BCC, and 3 with B. gladioli) were included. Eradication therapy, using heterogeneous combinations of intravenous, oral or nebulised antibiotics, was attempted in 11 patients. Six out of the 11 treated patients, and 4 out of the 6 untreated patients cleared the bacterium. Though not statistically significant, higher forced expiratory volume in one second and forced vital capacity at PC and consistency of treatment with in vitro antibiotic susceptibility tended to be associated with eradication. The management of PC was shown to be heterogeneous, thus impairing the statistical power of our study. Large prospective studies are needed to define whom to treat, when, and how. Conclusion: Pending these studies, we propose, due to possible spontaneous clearance, to check the presence of Burkholderia one month after PC before starting antibiotics, at least in the milder cases, and to evaluate a combination of IV beta-lactam + oral or IV fluoroquinolone + inhaled aminoglycoside.

Antimicrobial Strategies for Cystic Fibrosis

“…This problem is illustrated by another retrospective, multicenter study evaluating eradication protocols, where 6 of 11 patients treated with antibiotics cleared the infection, while 4 of 6 untreated patients cleared spontaneously. 77 Despite the evidence gap, eradication protocols are common and 12 of 17 CF centers in the United Kingdom routinely attempted eradication of new Burkholderia isolates. 78 Similarly, the evidence supporting maintenance therapy in chronic infection with Burkholderia spp.…”