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. 2011 Dec 21:1:18.
doi: 10.3389/fcimb.2011.00018. eCollection 2011.

Can early Burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy?

Alex Horsley  1 , Kevin Webb, Rowland Bright-Thomas, John Govan, Andrew Jones
Affiliations

Can early Burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy?

Alex Horsley et al. Front Cell Infect Microbiol. .

Abstract

Introduction: Organisms of the Burkholderia cepacia complex (BCC) are important pathogens in cystic fibrosis (CF). The majority of those who acquire BCC develop chronic infection but it can also result in rapid decline in a significant minority. In addition, chronic infection with Burkholderia cenocepacia in particular is regarded as a contraindication to lung transplantation in many units. Whilst aggressive antibiotic therapy is employed in CF to eradicate Pseudomonas aeruginosa before infection becomes irreversibly established, no formal assessment of such strategies has been previously reported for BCC, despite the apparent widespread adoption of this practice.

Methods: UK adult CF centers were surveyed about their current approach to new BCC infection. Outcomes of eradication therapy were assessed in patients attending the Manchester Adult CF Center with new BCC isolates between 1st January 2002 and 1st May 2011. Patients with previous infection with the same strain of BCC were excluded. BCC were identified at the national reference laboratories and confirmed by species-specific PCR and RecA sequencing.

Results: Routine use of therapies to attempt eradication of new BCC is commonly used in the UK (12/17 centers who responded). This typically involves a combination of intravenous and nebulised antibiotics. Of 19 eligible cases of new BCC infection, the organism has been eradicated in 7 (37%). Three of these did not receive specific eradication therapy. Of 14 patients who have received eradication therapy and completed follow up, BCC were cleared in only 4 (29%).

Conclusions: Attempted eradication of new BCC is a common practice in UK adult CF centers. A minority of patients clear the infection spontaneously and the effects of eradication therapies are at best modest. Early treatment may be associated with better outcomes, though there are insufficient data to support the use of any specific treatment regimen. A prospective, systematic evaluation of treatments and outcomes is required.

Keywords: Burkholderia cenocepacia; Burkholderia cepacia; Burkholderia multivorans; Eradication; cystic fibrosis.

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Figures

Figure 1
Figure 1
Estimated success of BCC eradication therapy in UK adult CF centers. In all but one of these centers, the practice was routinely applied to all new BCC infections.
Figure 2
Figure 2
Relative incidence of newly acquired B. multivorans and B. cenocepacia infections in CF patients attending the Manchester Adult CF Center. Incidence is expressed as number of cases in a calendar year per 100 patients. Total number of patients refers to that attending the clinic at the end of the year.
See this image and copyright information in PMC

References

    1. 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(Pt 1), 1206–1212 - PubMed
    1. Baldwin A., Mahenthiralingam E., Drevinek P., Pope C., Waine D. J., Henry D. A., Speert D. P., Carter P., Vandamme P., LiPuma J. J., Dowson C. G. (2008). Elucidating global epidemiology of Burkholderia multivorans in cases of cystic fibrosis by multilocus sequence typing. J. Clin. Microbiol. 46, 290–29510.1128/JCM.01818-07 - DOI - PMC - PubMed
    1. Ball R., Brownlee K. G., Duff A. J., Denton M., Conway S. P., Lee T. W. (2010). Can Burkholderia cepacia complex be eradicated with nebulised amiloride, and TOBI? J. Cyst. Fibros. 9, 73–7410.1016/S1569-1993(10)60281-0 - DOI - PubMed
    1. Biddick R., Spilker T., Martin A., LiPuma J. J. (2003). Evidence of transmission of Burkholderia cepacia, Burkholderia multivorans, and Burkholderia dolosa among persons with cystic fibrosis. FEMS Microbiol. Lett. 228, 57–6210.1016/S0378-1097(03)00724-9 - DOI - PubMed
    1. CF Foundation (2009). Patient Registry 2009 Annual Report. Bethseda, MD: Cystic Fibrosis Foundation

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