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Community-acquired urinary tract infections caused by Burkholderia cepacia complex in patients with no underlying risk factor

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Laila Nimri at Jordan University of Science and Technology
Laila Nimri
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Introduction: Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. The community-acquired urinary tract infections (CA-UTIs) are mostly caused by Escherichia coli, and other members of the family Enterobacteriaceae. Burkholderia cepacia is an opportunistic pathogen mainly affecting immunocompromised and hospitalized patients particularly those with prior broad-spectrum antibacterial therapy. Case presentation: Urine samples were collected from 157 outpatients clinically diagnosed with UTI and from 100 healthy control subjects. Samples were cultured on differential media and non- motile lactose- non fermentors colonies were identified by Remel RapID™ ONE system. The isolates were tested by disc diffusion method against 17 antimicrobial agents. Burkholderia was isolated as a single organism from four patients having uncomplicated infections, and one from recurrent infection. None of these patients has underlying risk factor for this pathogen. Identification of these isolates by Remel-RapID ONE™System was confirmed by recA gene amplification. The four isolates were resistant to lincomycin, nalidixic acid, oxacillin, and penicillin G. These cases received monotherapy of oral co-trimoxazole. Conclusions: Our findings would alert the urologists and diagnostic laboratories to the potential of B. cepacia complex infections in similar cases, and that this bacterium should not be ruled out.
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JMM Case Reports
Community-acquired urinary tract infections caused by Burkholderia cepacia complex
in patients with no underlying risk factor.
--Manuscript Draft--
Manuscript Number: JMMCR-D-16-00081R2
Full Title: Community-acquired urinary tract infections caused by Burkholderia cepacia complex
in patients with no underlying risk factor.
Article Type: Case Report
Section/Category: Urinary tract and reproductive organs
Order of Authors: Laila F Nimri, Ph.D.
Mamuno Sulaiman, MSc
Osama Bani Hani, MD
Abstract: Introduction: Urinary tract infections (UTIs) remain the common infections diagnosed in
outpatients as well as hospitalized patients. The community-acquired urinary tract
infections (CA-UTIs) are mostly caused by Escherichia coli, and other members of the
family Enterobacteriaceae. Burkholderia cepacia is an opportunistic pathogen mainly
affecting immunocompromised and hospitalized patients particularly those with prior
broad-spectrum antibacterial therapy.
Case presentation: Urine samples were collected from 157 outpatients clinically
diagnosed with UTI and from 100 healthy control subjects. Samples were cultured on
differential media and non- motile lactose- non fermentors colonies were identified by
Remel RapID™ ONE system. The isolates were tested by disc diffusion method
against 17 antimicrobial agents. Burkholderia was isolated as a single organism from
four patients having uncomplicated infections, and one from recurrent infection. None
of these patients has underlying risk factor for this pathogen. Identification of these
isolates by Remel-RapID ONE™System was confirmed by recA gene amplification.
The four isolates were resistant to lincomycin, nalidixic acid, oxacillin, and penicillin G.
These cases received monotherapy of oral co-trimoxazole.
Conclusions: Our findings would alert the urologists and diagnostic laboratories to the
potential of B. cepacia complex infections in similar cases, and that this bacterium
should not be ruled out.
First Author: Laila F Nimri, Ph.D.
Corresponding Author: Laila F Nimri, Ph.D.
Jordan University of Science & Technology
Irbid, Ir JORDAN
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JMM CASE REPORTS
Case report template
TITLE OF CASE: Community-acquired urinary tract infections caused by
Burkholderia cepacia complex in patients with no underlying risk factor
Laila Nimri 1, Mamuno Sulaiman2, Osama Bani Hani3
Address: 1 Department of Laboratory Medical Sciences, Jordan University of Science and
Technology, Irbid, Jordan; 2 Department of General and Pediatric Surgery, Jordan University
of Science and Technology, Irbid, Jordan.
Corresponding author: Laila Nimri
Corresponding author email address: nimri@just.edu.jo
The full names and institutional addresses for all authors must be included on the title page.
In order to assist us in choosing the correct editor to handle your paper, please choose one box in each of the
following categories:
Field: √Human ☐Dental ☐Veterinary/Fisheries
Subject: √Bacteriology ☐Virology ☐ Mycology ☐ Parasitology
Keywords: Please provide at least one keyword for each of the following categories:
Disease/Indication: Burkholderia cepacia complex; community-acquired; antimicrobial
susceptibility pattern; urinary tract infections
Pathology/Symptoms:
Treatment:
Abstract Up to 250 words summarising the case presentation and outcome (this will be shown on
preview and search panes)
Introduction: Urinary tract infections (UTIs) remain the common infections diagnosed in
outpatients as well as hospitalized patients. The community-acquired urinary tract infections
(CA-UTIs) are mostly caused by Escherichia coli, and other members of the family
Enterobacteriaceae. Burkholderia cepacia is an opportunistic pathogen mainly affecting
Manuscript Including References (Word document) Click here to download Manuscript Including References
(Word document) Nimri-JMMCR-D-16-00081R2
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immunocompromised and hospitalized patients particularly those with prior broad-spectrum
antibacterial therapy.
Case Presentation: Urine samples were collected from 157 outpatients clinically diagnosed
with UTI and from 100 healthy control subjects. Samples were cultured on differential media
and non- motile lactose- non fermentors colonies were identified by Remel RapID™ ONE
system. The isolates were tested by disc diffusion method against 19 antimicrobial agents.
Burkholderia was isolated as a single organism from four patients having uncomplicated
infections, and one from recurrent infection. None of these patients has underlying risk factor
for this pathogen. Identification of these isolates by Remel-RapID ONE™System and was
confirmed by recA gene amplification. The four isolates were resistant to colistin (polymyxin
E), lincomycin, nalidixic acid, oxacillin, penicillin G and polymyxin B. These cases received
monotherapy of oral co-trimoxazole.
Conclusion: Our findings would alert the urologists and diagnostic laboratories to the
potential of B. cepacia complex infections in similar cases, and that this bacterium should not
be ruled out.
Introduction Background; why do you think this case is important – why did you write it up?
Uncomplicated urinary tract infections (UTIs) are among the most frequently encountered
infections in the outpatient setting (Wagenlehner et al., 2011). Urine is normally sterile, but
intestinal bacteria originating from the anus may gain ascending entry through the urethra or
rarely from the bloodstream and cause an infection in the urinary system (Ronald, 2003).
The diagnosis of UTI is made based on the clinical picture of illness and urine culture.
Most UTIs are uncomplicated, and empirical treatment may be initiated for those patients
without the benefit of urine culture (Bahadin et al., 2011). Community-acquired infections
are often distinguished from nosocomial, or hospital-
acquired, diseases by the types of organisms that affect hospitalized patients. Patients with
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hospital-acquired UTIs have more comorbidities, and recurrent UTI, and have previously
received antibiotics more often than patients with CA-UTI (Horcajada et al., 2012). UTI
caused by B. cepacia was reported after renal transplantation (Li et al., 2003), and in
recurrent UTI and complete anatomical evaluation was recommended in such cases after
renal transplant (Zeeshan et al., 2012). Burkholderia cepacia may also be a causative
pathogen for nosocomial UTI in pediatric patients with predisposing factors (Lee et al.,
2015).
Escherichia coli remains the predominant uropathogen (80%) isolated in
uncomplicated acute community-acquired infections (CA-UTI) (Ronald, 2003). However, the
common pathogens traditionally associated with UTIs are changing many of their features,
particularly because of antimicrobial resistance. In addition, complicated UTI has a more
diverse etiology than uncomplicated urinary cases, and organisms that rarely cause disease in
healthy patients can cause significant disease in hosts with anatomic, metabolic, or
immunologic underlying disease (Ronald, 2003).
The knowledge of the uropathogens and their antibacterial susceptibility that may vary with
time is important for treatment. In many clinical laboratories, urine cultures account for
24%–40% of submitted cultures; and 80% of these urine cultures are submitted from the
outpatient setting (Wilson & Gaido, 2004). Rates of antibiotic resistance have considerably
changed, and consequently the empirical treatment of UTI requires constant updating based
on the antimicrobial susceptibility of the main uropathogens of the area, or country (Alós,
2005; Zeeshan et al., 2012).
This case study reports on CA-UTI caused by members of the Burkholderia cepacia complex
in otherwise healthy individuals and the isolates antibiotic resistance patterns.
Case Report
Urine samples were collected from 157 symptomatic outpatients visiting urology clinics, who
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were clinically diagnosed with UTI and from 100 healthy individuals, who didn’t report any
signs or symptoms of UTI in the past year and were willing to participate.
The study protocol was approved by the University Institutional Review Board (IRB). All
subjects signed an informed consent form before collecting the samples. A structured
questionnaire was filled in-person for each patient, and control subject by a trained
investigator. The questionnaire included demographic data such as sex, age, and questions
regarding the infection, clinical data and medication if any.
Investigations If relevant
Urine samples were cultured on selective media for Gram negative bacteria that were
incubated at 37oC for 48 hours. Cultures with a bacterial count of ≥ 103 CFU/mL of urine
were considered positive.
Diagnosis If relevant
Four of the non-motile, lactose-non fermenting isolates were identified biochemically as
Burkholderia cepacia using Remel-RapID ONE™System (Thermo Scientific, USA) based
on ERIC® electronic code compendium ((http://www.remel.com/eric/) designed to work
exclusively with this system. Identification of the four isolates as members of Burkholderia
cepacia complex was confirmed by amplifying the B. cepacia complex recA gene (1,040 bp)
using BCR1 and BCR2 primers (Mahenthiralingam et al., 2000). LB broth (Bioscience,
USA) was used for the storage of stock cultures of selected isolates.
This bacterium was isolated as a single organism from two males, and two females, age range
(28-45 years). Three isolates were from patients having uncomplicated infections, and one
isolate was from female patient having recurrent infections. The most common symptoms
reported by patients included urgency to urinate, frequency, discomfort and pain, typically in
the lower back and abdominal area, or when urinating.
The antibiotic susceptibility of the four B. cepacia complex isolates was assessed in vitro to
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19 antibiotics by the disk diffusion method on Mueller-Hinton Agar according to CLSI, 2012
and CLSI 2007 (Table 1). All four B. cepacia were resistant to colistin (polymyxin E),
lincomycin, nalidixic acid, oxacillin, polymyxin B and penicillin G. Three were resistant to
ampicillin, and cefixime, 2 were resistant to tetracycline, while only one was resistant to
amoxicillin, azithromycin, cefotaxime, piperacillin, and trimethoprim-sulfamethoxazole.
However, all four isolates were susceptible to ceftazidime, ciprofloxacin, gentamicin,
imipenem, and levofloxacin.
Treatment If relevant
Consisted of oral co-trimoxazole twice daily for 5-7 days, the dose is weight dependent.
Outcome and follow-up If relevant
Discussion
Uncomplicated community-acquired UTIs and in hospitalized patients are extremely
common infections (Khatri et al., 2012; Wagenlehner et al., 2011). In the current study,
Burkholderia cepacia complex isolates were among the bacterial species recovered from four
outpatients with uncomplicated infections; these patients had no underlying risk factor and no
history of recurrent UTI. There was a strong connection to the infection because this
bacterium was isolated as a single organism in these patients. Infections with this species
might be often misdiagnosed in the clinical laboratories because the identification of
suspected B. cepacia (formerly Pseudomonas cepacia) isolates is performed using a
combination of selective media, conventional biochemical analysis, commercial test systems
and PCR-based assays if available (van Pelt et al., 1999). These tests are not routinely used in
diagnostic laboratories and several laboratories have experienced difficulty in identifying this
bacterium. B. cepacia complex is an important nosocomial pathogen in patients, particularly
those with prior broad-spectrum antibacterial therapy (Gautam et al., 2011). However,
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Pseudomonas cepacia was first reported in renal calculi in non-immunocompromised patients
(Roberts & Speller, 1973).
An earlier study conducted in Jordan reported a high fatality rate in a nosocomial outbreak
caused by Burkholderia cepacia in patients suffering from diseases other than cystic fibrosis
(Bacteraemia or respiratory colonization) (Shehabi et al., 2004).
B. cepacia is one of the most antimicrobial-resistant organisms with high intrinsic resistance
encountered in the clinical laboratory; and such infections can be very difficult to treat
resulting in death in some cases (Gautam et al., 2011). All four urinary B. cepacia complex
isolates recovered in our study showed resistance or intermediate susceptibility to one or
more of the antimicrobial agents. B. cepacia complex strains are multidrug resistant due to
innate and acquired mechanisms of resistance (Aaron et al., 2000).
The four B. cepacia complex isolates in our study were preliminary identified by Remel-
RapID ONE™System and were confirmed by recA gene amplification. All four isolates were
resistant to colistin and polymyxin B, and these two antibiotics have been used as a
diagnostic test for B. cepacia (Nzula et al., 2002). A lack of binding sites on the
lipopolysaccharide of B. cepacia complex leads to intrinsic resistance to the cationic
antimicrobials, aminoglycosides and polymyxins (Arnold et al., 2007; Cox, and Wilkinson,
1991).
One of the isolates was resistant to trimethoprim-sulfamethoxazole (Table 1). B. cepacia is
often susceptible to trimethoprim-sulfamethoxazole, however, emerging resistance to these
antimicrobial agents are of increasing clinical concern, especially among cystic fibrosis (CF)
patients with B. cepacia complex respiratory infection, where only 5% of over 2600 strains
tested were susceptible to this agent (Zhou et al., 2007). However, the susceptibility profiles
of strains from CF patients may differ from those noted in strains from other patients because
presumably CF patients receive multiple courses of oral, intravenous, and aerosolized
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antibiotics (Moss, 1995).
Resistance to trimethoprim is mediated by production of dyhydrofolate reductase or
acquisition of outer membrane antibiotic efflux pumps that confer cross resistance to
chloramphenicol and fluoroquinolones (Burns et al., 1989). For serious infection with
trimethoprim-sulfamethoxazole-resistant strains or sulfa drug allergy, combination therapy
guided by in vitro susceptibility results should be administered.
In most UTI cases, empirical treatment without the benefit of a pre-therapy urine culture is
used. Most clinicians are not aware of this potential uropathogens. The antimicrobial use,
whether appropriate or inappropriate, is associated with the selection for antimicrobial-
resistant organisms colonizing or infecting the UT. Thus, infections caused by
antimicrobial-resistant organisms are associated with higher rates of treatment failures
(Abbo & Hooton, 2014). Therefore, knowledge of the antimicrobial susceptibility profile of
uropathogens causing uncomplicated CA-UTIs should guide therapeutic decisions
(Wagenlehner et al., 2011).
In conclusion, our finding of B. cepacia complex infections in four outpatients with no
underlying risk factor would alert the clinical diagnostic laboratories to the potential presence
of this significant pathogen and to include their identification in similar cases. In addition, the
multiresistance of most isolates to several tested antimicrobial agents should guide
therapeutic decisions.
References Vancouver Style
Aaron, S.D., Ferris, W., Henry, D.A., Speert, D.P., & Macdonald, N.E. (2000). Multiple
combination bactericidal antibiotic testing for patients with cystic fibrosis infected
with Burkholderia cepacia. Am J Respir Crit Care Med 161,1206-1212.
Abbo, L. M., & Hooton, T. M. (2014). Antimicrobial stewardship and urinary tract
infections. Antibiotics 3, 174-192.
Downloaded from www.microbiologyresearch.org by
IP: 94.249.116.223
On: Thu, 05 Jan 2017 10:51:44
Alós, J. I. (2005). Epidemiology and etiology of urinary tract infections in the community.
Antimicrobial susceptibility of the main pathogens and clinical significance of resistance.
Enferm Infecc Microbiol Clin 23, 3-8.
Arnold TM, Forrest GN, Messmer KJ. (2007). Polymyxin antibiotics for Gram-negative
infections. Am J Health Syst Pharm 64, 819-826.
Bahadin, J., Teo, S. H., & Mathew, S. (2011). Aetiology of community-acquired urinary
tract infection and antimicrobial susceptibility patterns of uropathogens isolated. Singapore
Med J 52, 415-420.
Burns, J.L., Lien, D.M, & Hedin, L.A. (1989). Isolation and characterization of
dihydrofolate reductase from trimethoprim-susceptible and trimethoprim-resistant
Pseudomonas cepacia. Antimicrob Agents Chemother 33, 1247-1251.
Clinical and Laboratory Standards Institute. (2007) Performance standards for
antimicrobial susceptibility testing. Seventh informational supplement M100-S17. CLSI,
Wayne, PA. USA.
Clinical and Laboratory Standards Institute (2012). Performance Standards for
Antimicrobial Susceptibility Testing; Twenty-second informational supplement M100-
S22:32. CLSI, Wayne, PA, USA.
Gautam, V., Singhal, L, &Ray P. (2011). Burkholderia cepacia complex: Beyond
Pseudomonas and Acinetobacter. Indian J Med Microbiol 29, 4-12.
Cox, A. D., Wilkinson, S. G. (1991). Ionizing groups in lipopolysaccharides of
Pseudomonas cepacia in relation to antibiotic resistance. Mol Microbiol 5, 641‐646.
Horcajada, J.P., Shaw, E., Padilla, B., et al., (2013). Healthcare-associated, community-
acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a
prospective multicentre cohort study in the era of antimicrobial resistance. Clin Microbiol
Infect 19, 962-968.
Downloaded from www.microbiologyresearch.org by
IP: 94.249.116.223
On: Thu, 05 Jan 2017 10:51:44
Khatri, B., Basnyat, S., Karki, A., et al. (2012). Etiology and antimicrobial susceptibility
pattern of bacterial pathogens from urinary tract infection. Nepal Med Coll J 14, 129-132.
Lee, K.W., Lee, S. K., & Cho, H. (2015). Burkholderia cepacia causing nosocomial urinary
tract infection in children. Child Kidney Dis 19, 143-147.
Li, F. K., Chan, K. W., Chan, T. M. & Lai, K. N. (2003). Burkholderia urinary tract
infection after renal transplantation. Transpl Infect Dis 5, 59-61.
Mahenthiralingam, E., Bischof, J., Byrne, S.K., Radomski, C., Davies, J.E., Av-Gay, Y.,
& Vandamme, P. (2000). DNA-Based diagnostic approaches for identification of
Burkholderia cepacia complex, Burkholderia vietnamiensis, Burkholderia multivorans,
Burkholderia stabilis, and Burkholderia cepacia genomovars I and III. J Clin Microbiol. 38,
3165-3173.
Moss, R. B. (1995). Cystic fibrosis: pathogenesis, pulmonary infection, and treatment. Clin
Infect Dis 21:839-849.
Nzula, S., Vandamme, P., Govan, J.R. (2002). Influence of taxonomic status on the in vitro
antimicrobial susceptibility of the Burkholderia cepacia complex. J Antimicrob Chemother.
50:265-269.
Roberts, J.B., & Speller, D.C. (1973). Letter: Pseudomonas cepacia in renal calculi. Lancet
2,1099.
Ronald, A. (2003). The etiology of urinary tract infection: traditional and emerging
pathogens. Dis Mon 49, 71-82.
Shehabi, A.A., Abu-Al-Soud, W., Mahafzah, A., Khuri-Bulos, N., Abu Khader, I., Ouis,
I.S., & Wadström T. (2004). Investigation of Burkholderia cepacia nosocomial outbreak
with high fatality in patients suffering from diseases other than cystic fibrosis. Scand J Infect
Dis 36, 174-178.
van Pelt, C., Verduin, C. M., Goessens, W.H. , et al. (1999) Identification of
Downloaded from www.microbiologyresearch.org by
IP: 94.249.116.223
On: Thu, 05 Jan 2017 10:51:44
Burkholderia spp. in the clinical microbiology laboratory: Comparison of conventional and
molecular methods.J Clin Microbiol 37, 2158-2164.
Wagenlehner, F. M., Hoyme, U., Kaase, M., et al. (2011). Uncomplicated urinary tract
infections. Dtsch Arztebl Int 108, 415–423.
Wilson, M.L., & Gaido. (2004). Laboratory Diagnosis of Urinary Tract Infections in Adult
Patients. Clin Infect Dis 38, 1150-1158.
Zeeshan, M., Aziz, T, & Naqvi, F. (2012). Recurrent urinary tract infection by Burkholderia
cepacia in a live related renal transplant recipient. J Pak Med Assoc 62, 496-498.
Zhou, J., Chen, Y., Tabibi, S., Alba, L., Garber, E., & Saiman, L. (2007). Antimicrobial
susceptibility and synergy studies of Burkholderia cepacia complex isolated from patients
with cystic fibrosis. Antimicrob Agents Chemother 51,1085-1088.
Figure/Table Captions Maximum of 2 figures and 2 tables
Table 1. The antimicrobial susceptibility testing of four B. cepacia complex isolates, zone of
inhibition (mm) as defined by CLSI, 2012 and CLSI, 2007.
Antibiotic
Symbol/
disk
potency
(g/mcg)
108P
078P
B.
cepacia
(mm)
087P
B.
cepacia
(mm)
047P
B. cepacia
(mm)
Amoxicillin
AMC-30
(08) R
(20) S
(19) S
Ampicillin
AM-10
(08) R
(15) S
(06) R
Azithromycin
AZM-15
(18) S
(18) S
(12) R
Cefixime
CFM-5
(13) R
(11) R
(10) R
Cefotaxime
CTX-30
(21) R
(24) I
(30) S
Ceftazidime
CAZ-30
(28) S
(29) S
(26) S
Ciprofloxacin
CIP-5
(30) S
(34) S
(35) S
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Gentamicin
CN-10
(23) S
(30) S
(18) S
Imipenem
IPM-10
(29)S
(30) S
(20) S
Colistin
CT-25
(00) R
(06) R
(00) R
Levofloxacin
LEV-5
(36) S
(34)S
(30)S
Lincomycin
L-2
(00)R
(00) R
(00) R
Nalidixic acid
NA-30
(14) R
(15) R
(13) R
Oxacillin
OX-1
(00) R
(00) R
(00) R
Penicillin G
P-10 I.U.
(08) R
(08) R
(11) R
Piperacillin
PRL-100
(28)S
(28)S
(14)R
Polymyxin B
PB-300U
(00) R
(00) R
(00) R
Tetracycline
TE-30
(22)S
(22)S
(08)R
Trimethoprim-
sulfamethoxazole
SXT-25
(18) S
(18) S
(06) R†
* R: resistant, I: intermediate, S: susceptible
† Isolate from female, recurrent infection
Abbreviations
UTI, urinary tract infection; B. cepacia, Burkholderia cepaci
Author statements: Please complete the following sections (refer to Information for authors for more
information on the requirements for these sections).
Funding information
This work was supported by the deanship of research at Jordan University of Science and
Technology, grant number 14/2014.
Acknowledgements.
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Ethical statement
The study protocol was approved by the University Institutional Review Board (IRB). All
subjects signed an informed consent form before collecting the samples.
Conflicts of interest
None
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1
Table 1. The antimicrobial susceptibility testing of four B. cepacia complex isolates,
zone of inhibition (mm) as defined by CLSI-2012.
Antibiotic
Symbol/
disk
potency
(g/mcg)
108P
B.
cepacia
(mm)
078P
B.
cepaci
a
(mm)
087P
B.
cepacia
(mm)
047P
B. cepacia
(mm)
Amoxicillin
AMC-30
(17) I*
(08) R
(20) S
(19) S
Ampicillin
AM-10
(08) R
(08) R
(15) S
(06) R
Azithromycin
AZM-15
(15) I
(18) S
(18) S
(12) R
Cefixime
CFM-5
(17) I
(13) R
(11) R
(10) R
Cefotaxime
CTX-30
(26) S
(21) R
(24) I
(30) S
Ceftazidime
CAZ-30
(21) S
(28) S
(29) S
(26) S
Ciprofloxacin
CIP-5
(36) S
(30) S
(34) S
(35) S
Gentamicin
CN-10
(18) S
(23) S
(30) S
(18) S
Imipenem
IPM-10
(22) S
(29)S
(30) S
(20) S
Levofloxacin
LEV-5
(36) S
(36) S
(34)S
(30)S
Lincomycin
L-2
(00) R
(00)R
(00) R
(00) R
Nalidixic acid
NA-30
(15) R
(14) R
(15) R
(13) R
Oxacillin
OX-1
(00) R
(00) R
(00) R
(00) R
Penicillin G
P-10 I.U.
(12) R
(08) R
(08) R
(11) R
Piperacillin
PRL-100
(27) S
(28)S
(28)S
(14)R
Tetracycline
TE-30
(00) R
(22)S
(22)S
(08)R
Trimethoprim-
sulfamethoxazole
SXT-25
(17) S
(18) S
(18) S
(06) R†
* R: resistant, I: intermediate, S: susceptible
† Isolate from female, recurrent infection
Table 1 Click here to download Table Burkholderia CA-UTIs-Table 1-
JMM Case Reports.docx
... In the past, identification of the pathogen in urine culture was a difficult task for the microbiology laboratories [1] and was often misidentified, even nowadays in India [3], as Pseudomonas spp. B. cepacia was identified as non-motile, non-lactose fermentative bacteria [25], without being able to distinguish between Pseudomonas and Burkholderia. ...
... Due to its high intrinsic resistance to antibiotics, B. cepacia is one of the most resistant germs encountered in the microbiology laboratory and is very difficult to treat [3]. In other studies, B. cepacia was found to be sensitive to ceftazidime, carbapenems and trimethoprim-sulfamethoxazole [10,12,30] and resistant to lincomycin, nalidixic acid, oxacillin, and penicillin G [25]. Other studies also reported susceptibility to levofloxacin [31]. ...
Urinary tract infections with Burkholderia cepacia. A narrative review
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  • Sep 2024
Burkholderia cepacia is an opportunistic Gram-negative bacillus that is found naturally in soil and water and usually causes respiratory infections in patients with cystic pulmonary fibrosis. Few cases of urinary tract infections with B. cepacia have been described in the literature, all of them clinical case presentations or case series. Therefore, we have compiled the data from the literature on this topic in a review to gain a better understanding of the etiopathogenesis, diagnosis and treatment methods of this disease. B. cepacia can lead to multidrug-resistant urinary tract infections in hospitals when surfaces and medical equipment are contaminated. The diagnosis is made after the onset of postoperative febrile syndrome or prolonged hospitalization in the intensive care unit. The evolution can be unfavorable, with the occurrence of sepsis and increased mortality.
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... Moreover, recurrent UTIs with B. cepacia is a rare finding, which highlights the importance of our study. UTIs with B. cepacia have been associated with bladder irrigation or use of contaminated hospital objects and liquids [2,4,5]. Pseudomonas spp. ...
... Given that they have similar biochemical properties, Burkholderia can be mislabeled as Pseudomonas, as occurred with the patient in our study. B. cepacia is one of the most antimicrobial-resistant organisms and treatment options are limited [2,4,5]. The patient does not specify on whose orders he was treated for pseudomonas, at that time he was seen for prostate cancer by a urologist and an oncologist, as well as a diabetologist for diabetes mellitus. ...
A rare case of urinary tract infection by Burkholderia cepacia
Article
Full-text available
  • Apr 2024
Burkholderia cepacia is a motile, aerobic, non-fermentative, gram-negative bacillus and has been widely documented as a lung pathogen in patients with cystic fibrosis and chronic granulomatous disease. It is documented as an important emerging cause of multi-drug resistant nosocomial infections, and an important cause of morbidity and mortality. A 64-year-old male patient visited the Nikea Primary Healthcare Center, Piraeus, Greece, referred by the family doctor (GP), for follow-up due a history of prostate cancer (patient on immunosuppression) and recurrent UTIs with subsequent admission to the hospital. Patient history revealed diabetes mellitus type 2, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, history of recurrent UTIs, with 4 hospitalizations in a tertiary hospital during the last 2 years, prostatic hypertrophy, 2 episodes of prostatitis before the diagnosis of prostate cancer Gleason score 6, at the end of 2019, with subsequent total prostatectomy, and radiotherapy. Patient history also revealed dysuria, frequent urination, pain and burning sensation during urination and erectile dysfunction. Urinalysis showed intense pyuria, abundance of micro-organisms and abundance of red blood cells. The urine culture grew monomicrobial Burkholderia cepacia 105 CFU/ml. The bacterium was identified by the RapID™ REMEL ONE identification system (Thermo Fisher Scientific). Antimicrobial susceptibility testing revealed susceptibility to antibiotics such as, Ceftazidime, Ciprofloxacin, Norfloxacin, Levofloxacin and Imipenem.The patient received treatment with Levofloxacin. Burkholderia cepacia infections outside the respiratory system are rare. Moreover, recurrent UTIs with B. cepacia is a rare finding, which highlights the importance of our study. UTIs with B. cepacia have been associated with bladder irrigation or use of contaminated hospital objects and liquids. B. cepacia is one of the most antimicrobial-resistant organisms and treatment options are limited. The patient was treated with Levofloxacin (3rd generation fluoroquinolone — Tavanic) 500 mg daily per os for 2 weeks, due to his history.
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... 23 Both COVID-19-Bcc and H7N9-Bcc have 0% resistance to trimethoprim-sulfamethoxazole, proving that trimethoprim-sulfamethoxazole can effectively treat Bcc infection. 24 B. multivorans and B. cepacia, belonging to the genus Burkholderia are prominent pathogens. Infections caused by Bcc are difficult to treat because of their apparent antibiotic resistance. ...
Convergence of Hypervirulence and Multidrug-Resistance in Burkholderia cepacia Complex Isolates from Patients with COVID-19
Article
Full-text available
  • Dec 2024
Purpose Burkholderia is a conditioned pathogen in the medical setting and mainly affects patients with cystic fibrosis. We found co-infection with Burkholderia cepacia complex (Bcc) in many patients with respiratory tract infections, including H7N9 and COVID-19. However, previous studies have not focused on co-infections with BCC and respiratory viruses. Therefore, this study attempted to clarify the evolution of COVID-19-Bcc and H7N9-Bcc in terms of genetic background, antibiotic resistance, and virulence phenotypes. Methods This study retrospectively collected 49 Bcc isolated from patients with H7N9 and COVID-19 in a tertiary hospital of Zhejiang Province, of which 42 isolates were isolated from patients with H7N9, seven isolates were isolated from patients with COVID-19. The collected isolates were tested for antibiotic susceptibility, Galleria mellonella infection model, and whole-genome COVID-19-Bcc Characterization. Results The test results of 49 strains of Bcc showed that the strains isolated from COVID-19 patients accounted for 57.1% of multidrug-resistance resistant strains. Statistical analysis of the median lethal time of G. mellonella showed that the median fatal time for COVID-19-Bcc was shorter and more virulent than that of H7N9-Bcc (P<0.05). The results of phylogenetic analysis indicated that COVID-19-Bcc may have evolved from H7N9-Bcc. Conclusion In this study, co-infection with BCC in many patients with respiratory tract infections, including H7N9 and COVID-19, was first identified and clarified that COVID-19-Bcc may have evolved from H7N9-Bcc and has the characteristics of hypervirulence and multidrug resistance.
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... Escherichia coli accounts for 75-90% of isolates; Staphylococcus saprophyticus for 5-15% (with particularly frequent isolation from younger women); and Klebsiella, Proteus, Enterococcus and Citrobacter species, along with other organisms, for 5-10% [1]. In complicated urinary tract infection (e.g., Catheter Associated Urinary Tract Infection), Escherichia coli remains the predominant organism [2], but other aerobic gram-negative bacilli, such as Pseudomonas aeruginosa and Klebsiella, Proteus, Citrobacter, Acinetobacter and Morganella species also are frequently encountered. Gram-positive bacteria (e.g., Enterococci and Staphylococcus aureus) and yeasts also are important pathogens encountered in complicated urinary tract infection. ...
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... Uncomplicated UTIs are most common and occur in generally healthy individuals with no physical or neurologic anomalies in the genitourinary system. Primarily seen in women in the outpatient setting and occasionally in some subsets of the male population like uncircumcised infants and elderly males [2][3][4] . Conversely, complicated UTIs are related to patientlevel features that affect urodynamics or compromise host immune mechanisms, such as urinary catheterization, urinary obstruction or retention, immunosuppression, renal failure, renal transplantation, and pregnancy. ...
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... [3] The clinical presentation of the infection during epidemics is variable, causing mainly bacteraemia and "Cepacia Syndrome"-bacteraemia with rapid deterioration of lung function. [2][3][4][5][6][7][8][9][10][11][12][13] It can also cause pneumonia [14,15], VAP [16,17], endophthalmitis [18,19], UTI [20,21], prostatitis [22], arthritis [23], spondylodiscitis [24], meningitis [25], endocarditis [26], pyomyositis [27] and peritonitis. [28] The B. Cepacia Complex infections especially affect the fragile and immunocompromised hospitalized population. ...
Management of an Epidemic Outbreak of Burkholderia Cepacia in A Hospital in The North of Italy
Article
Full-text available
  • Jan 2023
Background: Burkholderia Cepacia(B. Cepacia) is a gram-negative bacterium responsible both for colonization and for awide range of infections and clinical complications that significantly increasemorbidity and mortality. B. Cepacia is able to survive and replicate into antiseptic solutionsand invasive medicaldevices, thus representing potential reservoirs for hospital infections. Aim: Between April and August 2019 in the north of Italy, in two hospitals belonging to the same social healthdistrict (AULSS 8 Berica- West District), five cases of B. Cepaciasepsis were reported. This paper describes the epidemiological and microbiological investigation of the causalpathogen, the controlmeasures adopted to contain the epidemic and the results obtained. Methods: The Infection Control Committee (ICC) assessed relevant demographic characteristics and potential riskfactors of infected patients and collected environmental and equipment samples. Phenotypic and genotypic identification was carried out using microbiological methods of culture and MALDI-TOF technique. Findings: The B. Cepaciasepsis involved four oncological patientsand one cardiological patient who underwent aninvasive procedure under ultrasound guidance from April to August 2019 at one of the hospitals involved. The analyses highlighted the positivity for B. Cepacia in the ultrasound gel used for the eco-guidedprocedures. All samples were found to be sensitive to Meropenem. Conclusion: The infection controlmeasures put into effect permittedan effective management of the outbreakandhelped to reducethe risk of subsequent cases. The outbreak has revealed the need to draw up internal operating procedures that regulate punctually the grafting of invasive devices.
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... Case report study in India in 2017 included isolate of Ochrobactrum anthropi from patients with septicemia; antibiotic susceptibility was done using VITEK® 2 Compact system, which was multidrug- resistance, resistance to a wide range of antibioticsceftazidime, cefoperazone, cefepime, chloramphenicol, sulbactam, piperacillin /tazobactam, ciprofloxacin, imipenem, and meropenem while was susceptible to amikacin, tigecycline, cefepime-tazobactam, colistin, cotrimoxazole 29 . A study in Jordon 2017 included four isolates of B.cepacia complex isolates from the urine; antibiotic susceptibility was done using disk diffusion methods, which were resistant to lincomycin, nalidixic acid, oxacillin and penicillin G and sensitive to ceftazidime, ciprofloxacin, gentamicin, imipenem, and Levofloxacin 30 . One year prospective study in India 2018 included 43 isolates of B.cepacia complex isolates from blood and sputum, antibiotic susceptibility was done using VITEK 2 Compact system, showed Maximum Resistance with β-lactamase inhibitor drugs (83.7%) 31 . ...
Baghdad Science Journal Evaluation of some Virulence Factors and Drug Resistance of Bacteria Isolated from the Urine of Patients with TCC-Bladder Cancer
Article
Full-text available
  • Nov 2021
Urinary tract infections (UTIs) mean microbial pathogens in the urethra or bladder (lower urinary tract). Important risk factors for recurrent UTI include obstruction of the urinary tract, use of a bladder catheter or a suppressed immune system. This study aims to isolate and identify bacteria from patients with TCC-bladder cancer or patients with a negative cystoscope and estimate antibiotic susceptibility patterns and evaluate some of the virulence factors. From a total of 62 patients with TCC-BC or negative cystoscope, only 35 favorable bacterial growths were obtained, including Escherichia coli (UPEC), a significant bacterial isolate, and Stenotrophomonas maltophilia. The percentage of multi drug-resistance bacteria (MDR) was identified in (62.8%) while the extended drug-resistance bacteria (XDR) was (28.5%). All isolates were producer for biofilm either moderately 18/35 (49%) or strongly 18/35 (51%). Only 25/35 (71%) isolates were produced for siderophore, while 10/35 (29%) isolates were non-produced. Inducing cytochrome P450 expression protein was seen in (14/35) 40% isolates. In conclusion, patients with TCC-BC or negative cystoscope who had a urinary catheter or immune-compromised were at high risk of infecting with nosocomial or opportunistic pathogens, which could be develop antibiotic resistance, the central problem in the cohort of patients undergoing chemotherapy or immune cancer therapy
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... (6,7) However, the endemic form of Burkholderia cepacia septi caemia was rarely reported especially in immune-competent host. (8,9) The mortality rate was high. (13) ...
Young healthy man with fi ts
Article
Full-text available
  • Sep 2018
A young healthy male presented with high fever, fits and shock after running in hot weather. He was diagnosed and managed as heat stroke. Initial resuscitation failed to raise blood pressure and thus he was treated as septic shock. He also had multi-organ failure - DIC, carditis, liver involvement and renal involvement. Blood culture revealed growth of Burkholderia cepacia and the appropriate antibiotics were given. He had complete recovery. Key words - heat stroke, septic shock, multi-organ failure, Burkholderia cepacia
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Burkholderia cepacia infections at sites other than the respiratory tract: A large case series from a tertiary hospital in Madurai
Article
  • May 2023
Sparsely reported extrapulmonary Burkholderia cepacia complex (Bcc) infections highlights the importance of this study. This was a retrospective chart review of 37 patients with extrapulmonary Bcc infections admitted between December 2019 and July 2022 in a tertiary hospital. Males accounted for 70% of cases. 78% had atleast one underlying comorbid illness. Among 37 isolates, 22 were from blood, others include exudates, urine and peritoneal fluid. Susceptibility rates of ceftazidime, meropenem, minocycline, cotrimoxazole and levofloxacin were 88, 88, 70, 65.7 and 56.7% respectively. Eleven died of septic shock and 24 patients (64.8%) had good outcomes, while two were lost to followup.
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Antimicrobial Stewardship and Urinary Tract Infections
Article
Full-text available
  • Jun 2014
Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections.
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Etiology and antimicrobial susceptibility pattern of bacterial pathogens from urinary tract infection
Article
Full-text available
  • Jun 2012
Urinary tract infection (UTI) is the most common infection in both community and hospital patients. In majority of the cases, empirical antimicrobial treatment is practiced before the laboratory results of urine culture. Thus, antibiotic resistance may increase in urinary bacterial pathogens due to improper use of drugs. This study was designed to find out the etiological agents of UTI and their prevalence, and to determine the antimicrobial susceptibility pattern of the bacterial pathogens isolated from urine culture. This study was conducted in Kathmandu Model Hospital, Kathmandu, Nepal from April to October, 2009. Midstream Urine samples from 1323 patients suspected of UTI were analyzed by microscopy, and conventional semi-quantitative culture technique for the significant growth. Antimicrobial susceptibility test was performed for the isolates by Modified Kirby-Bauer disk diffusion method. Data were analyzed using SPSS software window version 16. The overall prevalence of UTI was found to be 18.89%. The most frequent causative organisms isolated were Escherichia coli (82.30%), Enterococcus faecalis (5.60%), Citrobacter freundii (3.60%), Enterobacter aerogenes (2.40%), Coagulase Negative Staphylococci (2.40%), Pseudomonas aeruginosa (1.20%), Proteus mirabilis (0.8%), Klebsiella pneumoniae (0.4%), and Staphylococcus aureus (0.4%). Nitrofurantoin and Amoxycillin were found to be the most effective antibiotic against gram negative and gram positive isolates respectively. E. coli was found to be the most common etiological agent of UTI and Nitrofurantoin was the most effective drug among the isolates.
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Uncomplicated Urinary Tract Infections
Article
Full-text available
  • Jun 2011
Urinary tract infections (UTIs) are among the most common types of bacterial infection in outpatient medicine. Rising rates of antibiotic resistance and a better understanding of the ecological adverse effects (collateral damage) of antibiotics warrant a reevaluation of the treatment recommendations for uncomplicated UTI. The new S3 guideline contains updated recommendations. The new S3 guideline is based on a review of publications on uncomplicated UTI retrieved by a systematic search of the Medline and Cochrane Library databases. Guidelines from abroad were also considered in the review. Uncomplicated UTI is classified as either uncomplicated cystitis (UC) or uncomplicated pyelonephritis (UP). The choice of a suitable antibiotic is determined by the following main criteria: the patient's individual risk profile and prior antibiotic treatment, if any; the spectrum of pathogens and antibiotic susceptibility; the proven efficacy of the antibiotic; the ecological adverse effects (collateral damage) of antimicrobial therapy; the side effects for the patient under treatment. On the basis of these criteria, co-trimoxazole/trimethoprim and fluoroquinolones can no longer be recommended as first-line empirical treatment for UC. Rather, the new recommended treatment of first choice consists of fosfomycin-trometamol, nitrofurantoin, or pivmecillinam. High-dose fluoroquinolones are still recommended, however, as first-line oral treatment for UP. Asymptomatic bacteriuria should only be treated in exceptional situations such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract. The new S3 guideline on uncomplicated UTI incorporates a forward-looking approach to the use of antibiotics in treating this common type of infection. It is intended to bring about a sustained improvement in the quality of care.
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Aetiology of community-acquired urinary tract infection and antimicrobial susceptibility patterns of uropathogens isolated
Article
Full-text available
  • Jun 2011
Antibiotic resistance among uropathogens causing urinary tract infection (UTI) is increasing worldwide. In most cases of UTI, family physicians can provide empirical treatment without the benefit of a pre-therapy urine culture. Knowledge of the aetiology and antimicrobial susceptibility patterns of uropathogens is important in order to determine the best empiric treatment option. This study aimed to determine the aetiology and antimicrobial susceptibility of uropathogens in culture-positive, community-acquired UTIs over a one-year period. This is a retrospective analysis of medical case records. All patients who were diagnosed and coded with UTI and had urine culture done were analysed. The prevalence of the UTI-causing organism and its antibiotic susceptibility was tabulated. Results were analysed with descriptive statistics. The chi-square and Fisher's exact tests were applied for categorical variables. The commonest organism isolated for all age groups and gender was Escherichia coli (74.5 percent) and Klebsiella spp. (8.7 percent). Among the oral antibiotics widely used in primary care in Singapore, the Enterobacteriaceae family was most susceptible to amoxicillin/clavulanate. There was no significant difference in the susceptibility of common oral antibiotics when tested against the Enterobacteriaceae for both male and female patients and between patients older than 65 years and those 65 years and below. Empirical treatment of community-acquired UTI with cotrimoxazole, ciprofloxacin, cephalothin and ampicillin is inadequate. Amoxicillin/clavulanate should be the drug of choice for empirical treatment instead.
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Burkholderia cepacia complex: Beyond pseudomonas and acinetobacter
Article
Full-text available
  • Jan 2011
Burkholderia cepacia complex (BCC) is an important nosocomial pathogen in hospitalised patients, particularly those with prior broad-spectrum antibacterial therapy. BCC causes infections that include bacteraemia, urinary tract infection, septic arthritis, peritonitis and respiratory tract infection. Due to high intrinsic resistance and being one of the most antimicrobial-resistant organisms encountered in the clinical laboratory, these infections can prove very difficult to treat and, in some cases, result in death. Patients with cystic fibrosis (CF) and those with chronic granulomatous disease are predisposed to infection by BCC bacteria. BCC survives and multiplies in aqueous hospital environments, including disinfectant agents and intravenous fluids, where it may persist for long periods. Outbreaks and pseudo-outbreaks of BCC septicaemia have been documented in intensive care units, oncology units and renal failure patients. BCC is phenotypically unremarkable, and the complex exhibits an extensive diversity of genotypes. BCC is of increasing importance for agriculture and bioremediation because of their antinematodal and antifungal properties as well as their capability to degrade a wide range of toxic compounds. It has always been a tedious task for a routine microbiological laboratory to identify the nonfermenting gram-negative bacilli, and poor laboratory proficiency in identification of this nonfermenter worldwide still prevails. In India, there are no precise reports of the prevalence of BCC infection, and in most cases, these bacteria have been ambiguously reported as nonfermenting gram-negative bacilli or simply Pseudomonas spp. The International Burkholderia cepacia Working Group is open to clinicians and scientists interested in advancing knowledge of BCC infection/colonisation in persons with CF through the collegial exchange of information and promotion of coordinated approaches to research.
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Burkholderia Cepacia Causing Nosocomial Urinary Tract Infection in Children
Article
  • Oct 2015
Purpose: Burkholderia cepacia is an aerobic, glucose–non-fermenting, gram-negative bacillus that mainly affects immunocompromised and hospitalized patients. Burkholderia cepacia has high levels of resistance to many antimicrobial agents, and therapeutic options are limited. The authors sought to analyze the incidence, clinical manifestation, risk factors, antimicrobial sensitivity and outcomes of B. cepacia urinary tract infection (UTI) in pediatric patients. Methods: Pediatric patients with urine culture-proven B. cepacia UTI between January 2000 and December 2014 at Samsung Medical Center, a tertiary referral hospital in Seoul, Republic of Korea, were included in a retrospective analysis of medical records. Results: Over 14 years, 14 patients (male-to-female ratio of 1:1) were diagnosed with B. cepacia UTI. Of 14 patients with UTI, 11 patients were admitted to the intensive care unit, and a bladder catheter was present in 9 patients when urine culture was positive for B. cepacia. Patients had multiple predisposing factors for UTI, including double-J catheter insertion (14.2%), vesico-ureteral reflux (28. 6%), congenital heart disease (28.6%), or malignancy (21.4%). Burkholderia cepacia isolates were sensitive to piperacillin-tazobactam and sulfamethoxazole-trimethoprim, and resistant to amikacin and colistin. Treatment with parenteral or oral antimicrobial agents including piperacillin-tazobactam, ceftazidime, meropenem, and sulfamethoxazole-trimethoprim resulted in complete recovery from UTI. Conclusion: Burkholderia cepacia may be a causative pathogen for nosocomial UTI in pediatric patients with predisposing factors, and appropriate selection of antimicrobial therapy is necessary because of high levels of resistance to empirical therapy, including aminoglycosides.
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Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: A prospective multicentre cohort study in the era of antimicrobial resistance
Article
  • Oct 2012
  • CLIN MICROBIOL INFEC
The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p <0.001), McCabe score II-III (48% vs 14%, p <0.001), Pitt score ≥2 (40% vs 31%, p 0.03), isolation of extended spectrum β-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p <0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01-1.07), McCabe score II-III (OR 3.2; 95% CI 1.8-5.5), Pitt score ≥2 (OR 3.2 (1.8-5.5) and HA-BUTI OR 3.4 (1.2-9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.
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Recurrent urinary tract infection by Burkholderia cepacia in a live related renal transplant recipient
Article
  • May 2012
  • J Pakistan Med Assoc
Burkholderia cepacia is high virulent organism usually causing lower respiratory tract infections especially in Cystic fibrosis (CF) patients and post lung transplant. Urinary tract infections with Burkholderia cepacia have been associated after bladder irrigation or use of contaminated hospital objects. Post renal transplant urinary tract infection (UTI) is the most common infectious complications. Recurrent urinary tract infection with Burkholderia cepacia is a rare finding. Complete anatomical evaluation is essential in case recurrent urinary tract infections (UTI) after renal transplant. Vesico-ureteric reflux (VUR) and neurogenic urinary bladder was found to be important risk factors.
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Burkholderia urinary tract infection after renal transplantation
Article
  • Mar 2003
  • TRANSPL INFECT DIS
Urinary tract infection is a common complication after renal transplantation. The etiologies are diverse and the bacterial agents may sometimes be acquired during the hospital stay. We report a patient who developed Burkholderia cepacia urinary tract infection after renal transplantation. The bacteria showed in vivo resistance to all of the available antibiotics. A graft nephrectomy was eventually required to clear the infection. The consequence of some fastidious infection may be catastrophic and early recognition and treatment is necessary to optimize the treatment.
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Isolation and characterization of dihydrofolate reductase from trimethoprim-susceptible and trimethoprim-resistant Pseudomonas cepacia
Article
  • Sep 1989
Trimethoprim resistance was investigated in cystic fibrosis isolates of Pseudomonas cepacia. Determination of the MIC of trimethoprim for 111 strains revealed at least two populations of resistant organisms, suggesting the presence of more than one mechanism of resistance. Investigation of the antibiotic target, dihydrofolate reductase, was undertaken in both a susceptible strain and a strain with high-level resistance (MIC, greater than 1,000 micrograms/ml). The enzyme was purified by using ammonium sulfate precipitation, gel filtration, and ion-exchange chromatography. Specific activities, molecular weights, isoelectric points, and substrate kinetics were similar for both enzymes. However, the dihydrofolate reductase from the trimethoprim-resistant strain demonstrated decreased susceptibility to inhibition by trimethoprim and increased susceptibility to inhibition by methotrexate, suggesting that these two enzymes are not identical. We conclude that the mechanism of trimethoprim resistance in this strain with high-level resistance is production of a trimethoprim-resistant dihydrofolate reductase.
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