Six-Year Molecular Analysis of
            <i>Burkholderia cepacia</i>
            Complex Isolates among Cystic Fibrosis Patients at a Referral Center for Lung Transplantation

Heath, D. F.; Hohneker, Kathy; Carriker, Charlene; Smith, Kelly; Routh, Jonathan C.; LiPuma, John J.; Aris, Robert M.; Weber, David J.; Gilligan, Peter H.

doi:10.1128/jcm.40.4.1188-1193.2002

Cited by 35 publications

(23 citation statements)

References 27 publications

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“…These findings substantiate previous reports of the spread of non-B. cenocepacia B. cepacia complex species including B. cepacia (genomovar I) (3), B. multivorans (28,46,68), and B. dolosa (3). Finally, the occurrence of isolates with distinct PFGE profiles but with the same BOX-PCR profiles suggests the nationwide environmental distribution of genetically diverging clones.…”

Section: Discussionsupporting

confidence: 80%

Transmission of Burkholderia cepacia Complex: Evidence for New Epidemic Clones Infecting Cystic Fibrosis Patients in Italy

et al. 2005

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To analyze national prevalence, genomovar distribution, and epidemiology of the Burkholderia cepacia complex in Italy, 225 putative B. cepacia complex isolates were obtained from 225 cystic fibrosis (CF) patients attending 18 CF centers. The genomovar status of these isolates was determined by a polyphasic approach, which included whole-cell protein electrophoresis and recA restriction fragment length polymorphism (RFLP) analysis. Two approaches were used to genotype B. cepacia complex isolates: BOX-PCR fingerprinting and pulsedfield gel electrophoresis (PFGE) of genomic macrorestriction fragments. A total of 208 (92%) of 225 isolates belonged to the B. cepacia complex, with Burkholderia cenocepacia as the most prevalent species (61.1%). Clones delineated by PFGE were predominantly linked to a single center; in contrast, BOX-PCR clones were composed of isolates collected either from the same center or from different CF centers and comprised multiple PFGE clusters. Three BOX-PCR clones appeared of special interest. One clone was composed of 17 B. cenocepacia isolates belonging to recA RFLP type H. These isolates were collected from six centers and represented three PFGE clusters. The presence of insertion sequence IS1363 in all isolates and the comparison with PHDC reference isolates identified this clone as PHDC, an epidemic clone prominent in North American CF patients. The second clone included 22 isolates from eight centers and belonged to recA RFLP type AT. The genomovar status of strains with the latter RFLP type is not known. Most of these isolates belonged to four different PFGE clusters. Finally, a third clone comprised nine B. pyrrocinia isolates belonging to recA RFLP type Se13. They represented three PFGE clusters and were collected in three CF centers.In the late 1970s and 1980s, reports on the recovery of Burkholderia cepacia from cystic fibrosis (CF) specimens began to appear (29), and the emergence of this pathogen was subsequently reviewed (25,35,36). Polyphasic taxonomic studies identified bacteria tentatively classified as B. cepacia as a complex of at least nine closely related species (genomovars). This B. cepacia complex consists of B. cepacia,

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Section: Discussionsupporting

confidence: 80%

Transmission of Burkholderia cepacia Complex: Evidence for New Epidemic Clones Infecting Cystic Fibrosis Patients in Italy

et al. 2005

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confidence: 99%

“…It is unclear why the incidence of B. cenocepacia has declined and that of B. multivorans has persisted, but it seems most likely that infection control measures are effective at limiting the interpatient spread of "epidemic" B. cenocepacia strains (12, 28). Furthermore, regional differences in B. multivorans recovery rates in cases of CF result in conflicting reports on the emergence and epidemiology of B. multivorans in this population (15,26,27,34,38).The introduction of stringent infection control measures has been shown to reduce the incidence of patient-to-patient spread of B. cenocepacia (5, 26) and presumably has reduced interpatient spread of other BCC species. However, the continued emergence of B. multivorans strains (4, 28) suggests acquisition from other sources, such as the natural environment.…”

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confidence: 99%

Elucidating Global Epidemiology of Burkholderia multivorans in Cases of Cystic Fibrosis by Multilocus Sequence Typing

et al. 2008

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Burkholderia multivorans is a prominent B. cepacia complex (BCC) species causing infection in people with cystic fibrosis. Despite infection control measures being introduced to reduce the spread of BCC there is a continued emergence of infections by B. multivorans. Our objective was to analyze a global collection of B. multivorans isolates, comparing those from environmental and clinical sources with those from reported outbreaks. Multilocus sequence typing (MLST) was performed on 107 B. multivorans isolates to provide a detailed analysis of the global population biology of this species. MLST resolved 64 B. multivorans sequence types. Twelve of these were globally distributed and associated with human infection; two of these (ST-21 and ST-375) were also composed of environmental isolates. These global lineages included strains previously linked to large outbreaks (e.g., French epidemic clone ST-16). Though few environmental isolates of B. multivorans were available for analysis, of six strains identified, three were identical to strains recovered from cystic fibrosis (CF) infection. Although the ability of B. multivorans to cause CF outbreaks is known, our report here concerning the existence of globally distributed B. multivorans CF strains is a new observation for this emerging B. cepacia complex pathogen and suggests that certain strain types may be better adapted to human infection than others. Common transmission-associated risk factors were not obviously linked to the globally distributed strains; however, the overlap in strains recovered from water environments, industrial products, and human infection suggests that environmental sources may be an important reservoir for infection with B. multivorans.Burkholderia multivorans is one of at least nine closely related gram-negative species that comprise the B. cepacia complex (BCC) (35). Originally these species were considered to be onion pathogens and were subsequently found to possess many beneficial properties for agricultural use (25). However, after more than two decades they have come to be widely known to cause problematic pulmonary infections in vulnerable individuals, particularly in people with cystic fibrosis (CF) (9).B. multivorans and Burkholderia cenocepacia are the two predominant BCC species causing human infections, though bacteria from all currently defined BCC species have been cultured from CF sputum (19,26,28). However, most research has concentrated on B. cenocepacia, which is widely considered to be the most virulent BCC species, with much less information available on B. multivorans. Comparison of recent epidemiological surveys (4, 12, 28) with older studies (19,26,32) suggests that the proportion of BCC-infected CF patients infected with B. multivorans is rising relative to the proportions of infection with B. cenocepacia and the remaining BCC species, with prevalence in the United States ranging from 38% (28) to 51% (4) of BCC infections. This proportional rise is due to a decline in the total incidence of B. cenocepacia while B. m...

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“…As far as we are aware, our isolates were from patients attending CF clinics rather than from hospitalized patients. It is likely that while transmission of B. multivorans between patients, such as that between siblings, as described by Mahenthiralingam or that between hospitalized patients, as described by Heath et al (5), may occasionally occur, most patients acquire the organism from the natural environment rather than from one another. Note that replacement of B. multivorans by transmissible strains of B. cenocepacia (of the III-A recA subgroup) has been reported for some patients (9) and that it is therefore important that patients with B. multivorans are segregated from those with these strains.…”

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confidence: 99%

Molecular Comparison of Isolates of Burkholderia multivorans from Patients with Cystic Fibrosis in the United Kingdom

Turton¹,

Kaufmann²,

Mustafa³

et al. 2003

J Clin Microbiol

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Burkholderia multivorans strains from 47 cystic fibrosis (CF) patients in 28 hospitals were compared by pulsed-field gel electrophoresis (PFGE) and flagellin (fliC) PCR-restriction fragment length polymorphism (PCR-RFLP) analysis. A considerable degree of genetic variation was evident, with each patient harboring a strain with a unique PFGE profile. Four sizes of fliC amplicons were produced, and these amplicons gave 13 RFLP types with restriction enzyme MspI. B. multivorans did not appear to spread between patients, suggesting that most CF patients acquire the organism from the natural environment.

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Six-Year Molecular Analysis of Burkholderia cepacia Complex Isolates among Cystic Fibrosis Patients at a Referral Center for Lung Transplantation

Cited by 35 publications

References 27 publications

Transmission of Burkholderia cepacia Complex: Evidence for New Epidemic Clones Infecting Cystic Fibrosis Patients in Italy

Transmission of Burkholderia cepacia Complex: Evidence for New Epidemic Clones Infecting Cystic Fibrosis Patients in Italy

Elucidating Global Epidemiology of Burkholderia multivorans in Cases of Cystic Fibrosis by Multilocus Sequence Typing

Molecular Comparison of Isolates of Burkholderia multivorans from Patients with Cystic Fibrosis in the United Kingdom

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