Background

Burkholderia cepacia is an aerobic gram-negative bacillus found in various aquatic environments. B cepacia is an organism of low virulence and is a frequent colonizer of fluids used in the hospital (eg, irrigation solutions, intravenous fluids). B cepacia rarely causes infection in healthy hosts. Based on phenotypic and genotypic analyses, B cepacia is divided into 9 genomovars that constitute the B cepacia complex (BCC).

Pathophysiology

B cepacia is almost always a colonizing organism rather than an infecting organism, but it may be important when isolated from body fluids that are ordinarily sterile. The pathophysiology of B cepacia infection mirrors that of other nonfermentative aerobic gram-negative bacilli.

Frequency

United States

B cepacia is ordinarily not a pathogen in the ambulatory setting, but it may colonize and/or infect the respiratory tract of patients with cystic fibrosis or bronchiectasis. B cepacia may also cause central venous catheter–related infections in patients with cancer and in those on hemodialysis. B cepacianosocomial pneumonia has rarely been reported, usually in patients treated with fluoroquinolones and ceftazidime. Skin and soft-tissue infections, surgical-wound infections, and genitourinary tract infections with B cepacia have also been reported.

According to the US Cystic Fibrosis Foundation’s 2016 National Patient Registry, 3% percent of all persons with cystic fibrosis were infected with B cepacia complex compared to 2.6% in 2012.^[1]

International

B cepacia is generally not a pathogen in the ambulatory setting, but it may colonize and/or infect the respiratory tract of patients with cystic fibrosis or bronchiectasis.

Mortality/Morbidity

If an intravenous infusate contains high numbers of B cepacia, direct injection into the bloodstream may result in gram-negative bacteremia.

Mortality and morbidity is highest in those with impaired pulmonary function (eg, cystic fibrosis, bronchiectasis, chronic granulomatosis disease).

Disease severity (defined by the Simplified Acute Physiology Score II) and age are independent predictors of mortality.^[2]

Malignancy and a higher SOFA score at onset of bacteremia are associated with high mortality rates.^[3]

Race

Burkholderia has no racial predisposition.

Age

Burkholderia has no age predisposition.

Prognosis

Signs and symptoms of B cepacia infections are related to the organ system involved and are indistinguishable from infections with other pathogens.

Clinical Presentation

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Author

Syed Faisal Mahmood, MBBS Associate Professor of Infectious Diseases, Program Director, Infectious Diseases Fellowship Program, Department of Medicine, Aga Khan University Hospital, Pakistan

Disclosure: Nothing to disclose.

Coauthor(s)

Sara Ahmed, MBBS, FCPS, MRCP(UK) Consultant Infectious Diseases, Aga Khan University Hospital , Pakistan

Sara Ahmed, MBBS, FCPS, MRCP(UK) is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.