Burkholderia cepacia causing liver and splenic abscess: Two case reports

Burkholderia cepacia infections are common among immunocompromised patients but multiple reports have shown that it can affect immunocompetent patients also. We are reporting two patients with multiple liver and splenic abscesses caused by Burkholderia cepacia. First case is a 54-year-old diabetic male presenting with fever, abdominal pain, bilateral lower limb weakness, and incontinence of urine. Second case is a 41-year-old male presenting with fever and confusion. Both had liver and splenic abscesses. Pus aspirated from the abscesses grew Burkholderia cepacia. Both responded to cotrimoxazole. Our case report emphasizes growing incidence of Burkholderia cepacia in immunocompetent patients.

Mortalidad en niños con bacteriemia por Burkholderia cepacia: una revisión sistemática

Introducción: En los niños, la bacteriemia debida a Burkholderia cepacia, es considerada una complicación grave y conducente a una elevada mortalidad. Con el objetivo de conocer la mortalidad asociada a esa condición, se realizó una revisión sistemática de la literatura médica. Material y Métodos: Se aplicó una estrategia de búsqueda bibliográfica con las palabras claves: "bacteriemia por B. cepacia", "humanos", "niños" y "adolescentes", como únicos filtros. Se informan la mediana y los valores intercuartílicos de la frecuencia de la mortalidad reportada por los estudios incluidos. Resultados: Se identificaron 92 estudios potencialmente útiles. De ellos, se descartaron 81, incluyéndose finalmente, 11 estudios. Se trató de descripciones retrospectivas de casos, salvo uno de ellos, que respondió a un diseño analítico caso-control. La mediana de la mortalidad reportada por esta revisión, fue 0 (Q25 = 0 y Q75 = 28,57%). Interpretación: Si bien la evidencia disponible es escasa y de baja calidad, sugiere que el curso clínico de esta afección no siempre resulta en una elevada mortalidad.

Background: Bacteremia due to Burkolderia cepacia in children is considered a severe complication and associated with high mortality incidence. In order to know the level of mortality associated with it, this systematic review of the literature was carried out. Methods: A search strategy was carried out with the keywords: "bacteremia by B cepacia and human" and "children" and "adolescents" as filters. Global frequency of mortality reported by the included studies was calculated and informed as median (Q2) and its interquartile values (Q1 and Q3). Results: The search identified 92 potentially useful studies. Of these, 81 were discarded, and then remained 11 studies to be included. One out of 11 studies is an analytic case-control design. Rest are retrospective case series. Related mortality median was 0 (Q25 = 0 and Q75 = 28,57%). Conclusion: Although the available evidence is scarce and of low quality, it suggests that clinical course of this condition does not always lead to high mortality rates.

Clinical profile, visual outcome and root cause analysis of post-operative cluster endophthalmitis due to Burkholderia cepacia complex

Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram?negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc). Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day?care wards to localize the source. Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia. Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow?up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection

Infección de piel y tejidos blandos por Burkholderia stabilis en un niño con quemaduras graves / Skin and soft tissue infection due to Burkholderia stabilis in a severely burned child

Resumen Las heridas por quemadura representan un grave problema, sobre todo en la población pediátrica, dada la severidad de su presentación y la morbimortalidad asociada. La infección es la complicación más frecuente y grave en el paciente quemado. Las bacterias que conforman el complejo Burkholderia cepacia (CBc) son capaces de causar enfermedades en plantas, humanos y animales. En el hombre pueden establecer infecciones crónicas y frecuentemente graves, por lo general en pacientes con fibrosis quística y en inmunocomprometidos. El CBc está compuesto por al menos 22 especies filogenéticamente muy relacionadas. El objetivo de esta publicación fue describir el primer caso de una infección de piel y partes blandas por Burkholderia stabilis, una especie poco frecuente, en un niño con grandes quemaduras en la Argentina. Las especies del CBc son intrínsecamente resistentes a la mayoría de los antimicrobianos disponibles clínicamente, como aminoglucósidos, quinolonas, polimixinas y β-lactámicos. Esto representa un serio problema en el momento de tratar las infecciones por las escasas opciones terapéuticas.

Abstract Burn wounds represent a serious problem, especially in the pediatric population, given the severity of their presentation and the associated morbidity and mortality. Infection is the most frequent and serious complication in the burned patient. Burkholderia cepacia (CBc) complex bacteria are capable of causing disease in plants, humans, and animals. In human beings they can establish chronic and frequently serious infections, generally in patients with cystic fibrosis and in immunocompromised patients. The CBc is composed of 22 phylogenetically closely related species. The objective of this publication was to describe the first report of a skin and soft tissue infection by Burkholderia stabilis, a rare species, in a child with extensive burns in Argentina. CBc species are inherently resistant to most clinically available antimicrobials, such as aminoglycosides, quinolones, polymyxins, and β-lactams. This represents a serious problem when treating infections, due to the limited therapeutic options.

Resumo As feridas por queimadura representam um grave problema, principalmente na população pediátrica, devido à gravidade de sua apresentação e morbimortalidade associada. A infecção é a complicação mais frequente e grave do paciente queimado. As bactérias que compõem o complexo Burkholderia cepacia (CBc) são capazes de causar doenças em plantas, humanos e animais. No homem, podem estabelecer infecções crônicas e freqüentemente graves, geralmente em pacientes com fibrose cística e imunocomprometidos. O CBc é composto, no mínimo, por 22 espécies filogeneticamente muito relacionadas. O objetivo desta publicação é descrever o primeiro caso de uma infecção de pele e tecidos moles por Burkholderia stabilis, uma espécie rara, em uma criança com queimaduras extensas na Argentina. As espécies do CBc são inerentemente resistentes à maioria dos antimicrobianos disponíveis clinicamente, como aminoglicosídeos, quinolonas, polimixinas e β-lactâmicos. Isso representa um problema sério na hora de tratar as infecções devido às opções terapêuticas limitadas.

Burkholderia cepacia outbreak in immunocompetent children in a tertiary hospital in Turkey: A case series

Objective: To report an outbreak of Burkholderia (B.) cepacia related to contaminated surface cleaner in the pediatric ward of a tertiary hospital in Turkey. Methods: This study retrospectively reported the outbreak occurred between January 16, 2018 and January 23, 2018. Twelve immunocompetent patients who developed a bloodstream infection a few days after the hospitalization and who were positive for B. cepacia were included. Environmental samples were collected from various areas in the hospital to find the source of the outbreak. Results: All patients had clinical and biochemical evidence of sepsis. None of the patients had an underlying disease or had a central venous catheter as a risk factor. B. cepacia was isolated from the samples taken from the surface cleaners. The antibiotic susceptibilities of B. cepacia isolates were identical in the surface cleaners with the isolates from the patients' blood cultures. The outbreak was controlled after removing the surface cleaners from use. None of the infected patients died during the outbreak. Conclusions: Nosocomial B. cepacia outbreak may occur in immunocompetent children as well. Rapid identification of the outbreak, defining the source and taking appropriate measures to control the outbreak are the key points in the management.

Diabetic foot infection caused by bacteria of the Burkholderia cepacia complex: report of an unusual case and a scoping literature review

ABSTRACT Burkholderia cepacia complex (BCC) is group of widespread gram-negative bacillus organized in over 20 phylogenetically distinct bacterial species. According to previous studies, BCC species pathogens are widely reported in patients with cystic fibrosis (CF), but not in individuals with diabetes mellitus (DM). In this case report, a 42-year-old male patient with DM and a foot infection caused by BCC is presented. The patient was hospitalized after antibiotic treatment failure and improved after two surgical debridement procedures and a high-dose extended infusion (EI) of meropenem. The team of vascular surgeons and the infectious disease specialists worked fervently to solve the case. Finally, a scoping review was conducted to map BCC infections in patients with DM.

Burkholderia cepacia complex: 11 years of surveillance in patients with Cystic Fibrosis in Posadas, Argentina

Abstract Cystic fibrosis patients with Burkholderia cepacia complex pulmonary infections have high morbidity and mortality. Worldwide, this disease is undergoing substantial epidemiological changes. Advances in the diagnosis and treatment have conditioned an increase in child sur-vival as well as in the proportion of affected adults. In order to know our reality, we refer to an epidemiological study in 64 CF patients during 11 years of surveillance, focusing on infections caused by Burkholderia species. Conventional and automated phenotypic tests, restriction fragment length polymorphism-recA, recA gene sequencing, and matrix-assisted laser desorp-tion ionization-time of flight (MALDI-TOF) mass spectrometry were applied. Bacterial isolates were also tested for antimicrobial susceptibility patterns. The prevalence of Burkholderia cepacia complex was 9.4%. Based on recA gene sequencing, the most common species identified were Burkholderia cenocepacia (67.3%) and Burkholderia vietnamiensis (20.3%). Ceftazidime and meropenem were the most active, inhibiting 53% and 46% of isolates, respectively. This report represents the first systematic study of Burkholderia infections in our CF population since beginning of monitoring and treatment and highlights the importance of continued longitudinal studies.

Resumen Los pacientes con fibrosis quística (FQ) con infecciones pulmonares causadas por especies del complejo Burkholderia cepacia tienen una alta morbimortalidad. En todo el mundo, esta enfermedad está experimentando cambios epidemiológicos sustanciales. Los avances en el diagnóstico y el tratamiento han condicionado un aumento en la supervivencia infantil, así como en la proporción de adultos afectados. Para conocer nuestra realidad, nos referimos a un estudio epidemiológico en 64 pacientes con FQ durante 11 años de vigilancia, focalizando las infecciones causadas por especies del género Burkholderia. Se aplicaron pruebas fenotípicas convencionales y automatizadas, polimorfismo de longitud de fragmentos de restricción-recA, secuenciación del gen recA y espectrometría de masa MALDI-TOF. Los aislados bacterianos también se analizaron para determinar los patrones de susceptibilidad antimicrobiana. La prevalencia de complejo B. cepacia fue del 9,4%. Con base en la secuenciación del gen recA, las especies más comunes identificadas fueron Burkholderia cenocepacia (67,3%) y Burkholderia vietnamiensis (20,3%). Ceftazidima y meropenem fueron los antibióticos más activos e inhibieron el 53 y el 46% de los aislamientos, respectivamente. Este informe representa el primer estudio sistemático de las infecciones por Burkholderia en nuestra población desde el comienzo de la monitorización y el tratamiento, y resalta la importancia de continuar los estudios de vigilancia longitudinales.

Burkholderia cepacia an emerging cause of septicaemia, in an intensive care unit from a tertiary care hospital, Nellore, India

Background: Burkholderia cepacia is highly virulent and multidrug resistant organism to cause fatal and serious infections in ICUs leads to rise in mortality and morbidity. aim of present study was to know the prevalence of Burkholderia cepacia in blood stream infection in Intensive Care Unit and to know the drug susceptibility.Methods: This is a prospective study was carried out in the Intensive Care Unit and Department of Microbiology, Narayana Medical College, Nellore, from February to March 2018. As a part of routine investigations Blood, urine, sputum or tracheal secretions sent for culture and sensitivity to the Microbiology laboratory. By conventional method, all the samples were cultured (except blood) onto Blood agar, Chocolate agar and MacConkey, s agar; incubated for 18-24 hours at 37?C. Blood cultures were performed in BACT/ Alert 3D (Biomeriux), only positives were subculture by conventional method. Further analysis was done in culture positive samples only.Results: A total of 448 patients admitted in ICU were included in the study, from them 586 samples were collected. out of which we got 238 culture positives. Among them 19 patients were positive for Burkholderia cepacia, most of them isolated from blood (78.9%), followed by respiratory secretions (21.1%) and none of them were isolated from urine samples. Most of the isolates were sensitive to Meropenam and Tigecycline (89.4%) followed by minocycline (84.2%), ceftazidime (73.6%), levofloxacin (63.1%). While B. cepacia isolates showed high resistance to cefaperazone-sulbactam, ciprofloxacin, ticarcillin-clavulanic acid with (84.2%), (89.4%), (89.4%) respectively.Conclusions: To conclude that, Burkholderia cepacia is one of the emerging causes of septicemia with multidrug resistance, cross contamination may be the root cause so it should be treated quickly and effectively.

Mortalidad en fibrosis quística: análisis retrospectivo de cinco años en institución de alta complejidad: Medellín - Colombia / Cystic fibrosis mortality: retrospective analysis of five years in a highly complex institution: Medellín - Colombia

INTRODUCTION: cystic fibrosis (CF) is a chronic, progressive disease with multisystem involvement and high mortality. An early diagnosis and a multidisciplinary approach lead to longer survival and better quality of life. OBJECTIVE: to characterize the patients who died with CF diagnosis in the period between 2011 and 2017 in the Hospital Universitario San Vicente in Colombia. METHODOLOGY: descriptive study of case series, with retrospective data collection. Results: 168 patients with CF were found in follow-up at the institution during the study period, of which 17 died (10,1%). Eleven deaths corresponded to children under 15 years old (64.7%), with equal distribution of gender (women 52.9% and men 47.1%). The median age at diagnosis was 3 years and median death 12 years. The most frequent clinical compromise was sinopulmonary and gastrointestinal. Pulmonary hypertension occurred in 29.4%. All the patients had a severe functional and nutritional compromise and 82.4% were colonized by Pseudomona aeruginosa. None had multidisciplinary management and most had a low socioeconomic level. BiPAP was used as a palliative measure in 6 patients and all died from ventilatory failure. CONCLUSION: CF mortality in our population continues to present at an early age. The diagnosis of the disease is still made late, compared to developed countries. There was a high proportion of bacterial colonization of the airway and the patients presented a severe clinical and functional status before dying.

INTRODUCCIÓN: la fibrosis quística (FQ) es una enfermedad crónica, progresiva, con compromiso multisistémico y de alta mortalidad. Un diagnóstico temprano y un manejo multidisciplinario llevan a una mayor sobrevida y mejor calidad de vida. OBJETIVO: caracterizar los pacientes que fallecieron con diagnóstico de FQ en el periodo comprendido entre 2011 y 2017 en el Hospital Universitario San Vicente Fundación (HUSVF) de Colombia. METODOLOGÍA: estudio descriptivo de series de casos, con recolección de la información de forma retrospectiva. RESULTADOS: Se encontraron 168 pacientes con FQ en seguimiento en la institución durante el periodo del estudio, de los cuales 17 fallecieron (10.1%). Once muertes correspondieron a menores de 15 años (64.7%), hubo una distribución de género equitativa (mujeres 52.9% y hombres 47.1%). La mediana de edad al momento del diagnóstico fue de 3 años y la de muerte 12 años. El compromiso clínico más frecuente fue sinopulmonar y gastrointestinal. La hipertensión pulmonar se presentó en el 29.4%. Todos los pacientes tenían un grave compromiso funcional, nutricional y el 82,4% estaban colonizados por Pseudomonas aeruginosa. Ninguno tuvo manejo multidisciplinario y la mayoría presentaban un bajo nivel socieconómico. En 6 pacientes se utilizó BiPAP como medida paliativa y todos murieron por falla ventilatoria. CONCLUSIÓN: la mortalidad por FQ en nuestra población se sigue presentando a edades tempranas. El diagnóstico de la enfermedad aún se realiza de forma tardía, comparado con países desarrollados. Hubo alta proporción de colonización bacteriana de la vía aérea y los pacientes presentaron un estado clínico y funcional grave antes de morir.

Ultrasound gel as a source of hospital outbreaks: Indian experience and literature review

Purpose: Hospital outbreaks are observed increasingly worldwide with various organisms from different sources such as contaminated ultrasound gel, intravenous (IV) fluids and IV medications. Among these, ultrasound gel is one of the most commonly reported sources for Burkholderia cepacia complex (Bcc) outbreaks. In this study, we describe our experience on investigation and the management of Bcc bacteraemia outbreak due to contaminated ultrasound gel from a tertiary care centre, South India. Materials and Methods: Over a 10-day period in October 2016, seven children in our Paediatric intensive care unit (ICU) were found to have bacteraemia with Bcc isolated from their blood culture. Repeated isolation of the same organism with similar antimicrobial susceptibility pattern over a short incubation period from the same location, confirmed the outbreak. An active outbreak investigation, including environmental surveillance, was carried out to find the source and control the outbreak. Isolates were subjected to multi-locus sequence typing (MLST) and global eBURST (goeBURST) analysis. Results: Environmental surveillance revealed contaminated ultrasound gel as the source of infection. MLST and goeBURST analysis confirmed that the outbreak was caused by a novel sequence type 1362 with the same clonal complex CC517. The outbreak was controlled by stringent infection control measures, withdrawal of contaminated ultrasound gel from regular usage and implementing the practice of using ultrasonogram (USG) probe cover for USG screening and guided procedures. Conclusion: This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated ultrasound gel can be a potential source for healthcare-associated infection, which cannot be overlooked.

Pseudobrote por Burkholderia cepacia en dos unidades de cuidados intensivos de un Hospital Universitario en Bogotá - Colombia / Pseudo-Outbreak of Burkholderia cepacia in two intensive care unit in a University Hospital in Bogotá - Colombia

Introducción: Burkholderia cepacia es causante de brotes cuyo origen frecuentemente son fuentes ambientales. Materiales y métodos: Ante la sospecha de brote por B. cepacia en hemocultivos. Se realizó toma de cultivos ambientales y de insumos. Los aislamientos microbiológicos fueron sometidos a análisis molecular. Resultados: Se identificaron 8 pacientes con hemocultivos para B. cepacia en la UCI Adultos y UCI Pediátrica, edades entre 3 meses y 88 años, Los hemocultivos fueron tomados a través de catéter venoso central. Ningún paciente presentó infección por este microorganismo. Se documentó crecimiento de B. cepacia en lote de bolsitas ("sachet") jabón de clorhexidina al 4% y en lavamanos que se correlacionaron con el clon identificado en los pacientes. Con el retiro del lote de jabón de clorhexidina, optimización de los procesos de limpieza y desinfección, lavado de manos y medidas de aislamiento se controló el pseudobrote. Conclusiones: Se presenta un pseudobrote por B. cepacia causado por la contaminación de un lote de clorhexidina jabón y de los lavamanos, llamando la atención acerca de la posibilidad de contaminación de antisépticos con este microorganismo.

Introduction: The Burkholderia cepacia has been described as an outbreaks-causing agent, in which case frequently corresponds to environmental sources. Materials and Methods: Having the clinical suspicion of an outbreak or a pseudo-outbreak of B. cepacia in an Intensive Care Unit (ICU), samples in sterile solutions were sent to the laboratory for microbiologic study and molecular analysis. Results: Eigth patients with positive blood cultures for B. cepacia were identifed in the adults and pediatric ICU, ages between 3 months to 88 years. Blood cultures were taken through a central venous catheter. None of the patients presented clinical manifestations of infection. There was a positive culture of B. cepacia in a chlorhexidine sachet soap batch and in samples from the washbasin that was correlated with molecular analysis with patient samples. The withdrawal of the chlorhexidine sachet soap batch plus the optimization of cleaning and disinfection processes and patient isolation, were effective to control the pseudo-outbreak, without presenting infection. Conclusions: One pseudo-outbreak was documented by B. cepacia, affecting the adult and pediatric ICU caused by the contamination of a chlorhexidine sachet soap batch and the washbasins.

Identification and Characterization of Various Pseudomonas Species from Distinct Clinical Specimens: Antibiogram and Resistance Pattern

P. aeruginosa accounts for a significant proportion of nosocomial infections. This study was conducted to assess the prevalence, levels of antimicrobial susceptibility and resistance mechanisms of Pseudomonas from various clinical samples. P. aeruginosa accounts for a significant proportion of nosocomial infections. This study was conducted to assess the prevalence, levels of antimicrobial susceptibility and resistance mechanisms of Pseudomonas from various clinical samples. Methods: The study was conducted in a tertiary care hospital, over a period of 1 year. After identification of genus Pseudomonas, the speciation was done by biochemical tests and by VITEK 2. Antibiotic susceptibility was determined by disc diffusion method. Extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) production were detected by the combined disc diffusion test. Results: They were predominantly isolated from pus (44.3%), followed by blood (24.05%), body fluids (13.92%) and sputum (12.03%). The highest number of isolates were pseudomonas aeruginosa (64.56%) followed by p. fluroscence 19.62%, p. putida 7.6%, p. stutzeri 1.9%, p. alcaligens 1.9%, burkhelderia cepacia complex (BCC) (previous designation: pseudomonas cepacia) 1.9% and 2.53% isolate of burkhelderia pseudomallei (previous designation: pseudomona spseudomallei). Conclusion: This study examined the prevalence of pseudomonl infections, and its susceptibility patterns to different antibiotics. The presence of antibiotic-resistant P. aeruginosa isolates could be attributed to β-lactamase production and the use of multiple drug resistance efflux pump. It therefore calls for a very judicious, rational treatment regimens prescription by the physicians to limit the further spread of antimicrobial resistance among the P. aeruginosa strains.

El controvertido complejo Burkholderia cepacia, un grupo de especies promotoras del crecimiento vegetal y patógenas de plantas, animales y humanos / The controversial Burkholderia cepacia complex, a group of plant growth promoting species and plant, animals and human pathogens

El complejo Burkholderia cepacia está formado por 22 especies conocidas como patógenos oportunistas en personas inmunocomprometidas, especialmente en aquellas con fibrosis quística. También se aíslan de infecciones nosocomiales y son difíciles de erradicar debido a su capacidad intrínseca para resistir una gran variedad de antibióticos. En general, estas especies presentan genomas de gran tamaño (hasta 9 Mpb) divididos en 2-5 replicones. Esta característica aporta una gran versatilidad metabólica, que se considera importante para habitar el suelo, el agua, las plantas, incluso los nódulos en leguminosas. Algunas especies del complejo B. cepacia exhiben actividades benéficas, como biorremediación, biocontrol y promoción del crecimiento vegetal. No obstante, debido a su papel en infecciones de humanos, su uso en la agricultura está restringido. El complejo B. cepacia es un tema constante de estudio debido a su impacto en el sector salud y su potencial en la agricultura. En este trabajo se examina la historia del complejo B. cepacia y se revisa la información reciente relacionada con este grupo de bacterias.

The Burkholderia cepacia complex is a group of 22 species, which are known as opportunistic pathogens in immunocompromised people, especially those suffering from cystic fibrosis. It is also found in nosocomial infections and is difficult to eradicate due to intrinsic resistance to several antibiotics. The species have large genomes (up to 9 Mbp), distributed into 2-5 replicons. These features significantly contribute to genome plasticity, which makes them thrive in different environments like soil, water, plants or even producing nodules in legume plants. Some B. cepacia complex species are beneficial in bioremediation, biocontrol and plant-growth promotion. However, because the B. cepacia complex is involved in human infection, its use in agriculture is restricted. B. cepacia complex is being constantly studied due to the health problems that it causes and because of its agricultural potential. In this review, the history of B. cepacia complex and the most recently published information related to this complex are revised.

Burkholderia cepacia, cystic fibrosis and outcomes following lung transplantation: experiences from a single center in Brazil

OBJECTIVES: To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS: We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS: From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION: The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.

Clinical distribution and antimicrobial resistance of 98 Burkholderia cepacia strains / 中国感染控制杂志

Objective To analyze antimicrobial resistance of clinically isolated Burkholderia cepacia (B.cepacia),and provide evidence for clinical rational antimicrobial use.Methods B.cepacia isolated from clinical specimens between January 2013 and December 2014 were analyzed retrospectively,antimicrobial susceptibility results were statistically analyzed.Results A total of 98 isolates of B.cepacia between January 2013 and December 2014 were isolated,the main specimen was sputum(n =86,87.76 ％),the main department distribution was intensive care unit(n =46,46.94％),resistance rate of B.cepacia to ticarcillin / clavulanic acid was highest(73.47％),resistance rates to piperacillin / tazobactam and cefoperazone / sulbactam were both 16.33％,resistance rate to minocycline was the lowest(5.10％).Conclusion Infection caused by B.cepacia is high,prevention and control of healthcare-associated infection should be strengthened,early etiological examination should be performed,antimicrobial treatment should be combined with antimicrobial susceptibility results.

A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India.

Burkholderia cepacia complex (BCC) is a significant opportunistic pathogen in hospitalized and immunocompromised patients, particularly in cystic fibrosis. It is widely distributed in natural habitats such as soil and water and frequently encountered in nosocomial outbreaks due to contaminated disinfectants and medical devices. However reports on outbreaks due to this organism are lacking from the Indian subcontinent. We report here a sporadic outbreak due to BCC which occurred in the pediatric Intensive Care Unit of our institute, the probable source being contaminated distilled water. The isolate from three babies and environmental sources including distilled water were identical and confirmed as BCC. Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.

Polyphasic characterisation of Burkholderia cepaciacomplex species isolated from children with cystic fibrosis

Cystic fibrosis (CF) patients with Burkholderia cepacia complex (Bcc) pulmonary infections have high morbidity and mortality. The aim of this study was to compare different methods for identification of Bcc species isolated from paediatric CF patients. Oropharyngeal swabs from children with CF were used to obtain isolates of Bcc samples to evaluate six different tests for strain identification. Conventional (CPT) and automatised (APT) phenotypic tests, polymerase chain reaction (PCR)-recA, restriction fragment length polymorphism-recA, recAsequencing, and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) were applied. Bacterial isolates were also tested for antimicrobial susceptibility. PCR-recA analysis showed that 36 out of the 54 isolates were Bcc. Kappa index data indicated almost perfect agreement between CPT and APT, CPT and PCR-recA, and APT and PCR-recA to identify Bcc, and MALDI-TOF and recAsequencing to identify Bcc species. The recAsequencing data and the MALDI-TOF data agreed in 97.2% of the isolates. Based on recA sequencing, the most common species identified were Burkholderia cenocepacia IIIA (33.4%),Burkholderia vietnamiensis (30.6%), B. cenocepaciaIIIB (27.8%), Burkholderia multivorans (5.5%), and B. cepacia (2.7%). MALDI-TOF proved to be a useful tool for identification of Bcc species obtained from CF patients, although it was not able to identify B. cenocepacia subtypes.

Study of Potassium Solubilizing Bacteria from Limestone Mining Area in Palimanan, Cirebon Quarry

Aims: Potassium is an essential macronutrient for the growth and development of plants. Most of potassium in the soil presented in mineral forms or non-exchangeable forms which are not available for plants. The microbial activity facilitated to release of mineral forms or non-exchangeable potassium to the exchangeable or water-soluble. This study was aimed to isolate, select, and characterize of the selected potassium solubilizing bacteria from limestone mining area in Palimanan, Cirebon Quarry. Methodology and results: Isolation and selection of bacteria was done based on potassium dissolving index in Aleksandrov media containing feldspar, non-exchangeable potassium. Thirty seven isolates of potassium solubilizing bacteria were obtained in this study. Three isolates showed higher dissolution index, namely KQC.4B.1, KQC.5A.4, and KQC.5C.5. All of isolates were Gram negative bacteria, short-rod formed, and able to dissolve potassium concentration on 10th and 20th days. The three isolates showed 99.9% physiologically similar with Burkholderia cepacia. Futhermore by using 16S rRNA gene identification, isolate KQC.5C.5 closely related with B. cepacia with 99% identity. The application of isolate KQC.5C.5 on soil showed that the isolate was able to release the solution K formed after 10th day incubation. Conclusion, significance and impact of study: Potassium solubilizing bacteria (B. cepacia) could use as a biological fertilizer for providing potassium which is available to plants grown on reclamation area of limestone quarry.

Burkholderia Sepsis in Children as a Hospital-Acquired Infection

PURPOSE: Hospital-acquired Burkholderia cepacia (B. cepacia) infection are not commonly recorded in patients without underlying lung disease, such as cystic fibrosis and chronic granulomatous disease. However, in 2014, B. cepacia appeared more frequently in pediatric blood samples than in any other year. In order to access this situation, we analyzed the clinical characteristics of B. cepacia infections in pediatric patients at our hospital. MATERIALS AND METHODS: We conducted a retrospective study of blood isolates of B. cepacia taken at our hospital between January 2004 and December 2014. Patient clinical data were obtained by retrospective review of electronic medical records. We constructed a dendrogram for B. cepacia isolates from two children and five adult patients. RESULTS: A total of 14 pediatric patients and 69 adult patients were identified as having B. cepacia bacteremia. In 2014, higher rates of B. cepacia bacteremia were observed in children. Most of them required Intensive Care Unit (ICU) care (12/14). In eleven children, sputum cultures were examined, and five of these children had the same strain of B. cepacia that grew out from their blood samples. Antibiotics were administered based on antibiotic sensitivity results. Four children expired despite treatment. Compared to children, there were no demonstrative differences in adults, except for history of ICU care. CONCLUSION: Although there were not many pediatric cases at our hospital, awareness of colonization through hospital-acquired infection and effective therapy for infection of B. cepacia is needed, as it can cause mortality and morbidity.

Efecto de un bioinoculante a partir de consorcios microbianos nativos fosfato solubilizadores, en el desarrollo de pastos Angleton (Dichantium aristatum) / Effect of bio-inoculant from microbial consortia phosphate solubilizing natives in development of pastures (Dichantium aristatum)

El objetivo fue evaluar la capacidad solubilizadora de fosfatos de consorcios formados por bacterias nativas de los géneros Burkholderia cepacia, Pseudomonas sp, Pseudomonas luteola y Pantoea sp, con el fin de encontrar el más eficiente. Se realizaron pruebas de antagonismo entre las cepas y se formaron consorcios probando todas las combinaciones posibles en las concentraciones de 10(6), 10(7), 10(8) UFC/mL. Se realizaron evaluaciones cualitativas y cuantitativas de la solubilización de fosfatos y teniendo en cuenta éstos resultados, se preparó un bioinoculante el cual fue evaluado en semillas de plantas de pasto angleton (Dichantium aristatum) a escala de laboratorio, utilizando un diseño estadístico completamente al azar (DCA) con 3 tratamientos y 5 repeticiones: Tratamiento 1 semillas (control), Tratamiento 2, semillas tratadas con el consorcio de microorganismos seleccionado y Tratamiento 3, semillas tratadas con fertilizantes comerciales DAP y Urea. Se evaluaron las variables número de hojas, área foliar, longitud de la planta, longitud de la raíz y peso seco de todas las plantas. Los resultados de la prueba de antagonismo indicaron que no existe inhibición en el crecimiento de las cepas evaluadas, por lo tanto se formaron consorcios los cuales mostraron mayor eficiencia en la solubilización del fósforo, destacándose el consorcio formado por Pantoea sp + Pseudomonas sp a una concentración de 10(8) UFC/mL y con índices de solubilización de 5,3 y 842 ppm. En las plantas se evidenció un incremento significativo en los parámetros peso seco y área foliar usando el consorcio microbiano, indicando mayor beneficio en comparación con el control.

The objective was to evaluate the ability of phosphate solubilizing consortium of native bacteria of the genusBurkholderia cepacia, Pseudomonas sp, Pseudomonas luteola and Pantoea sp, in order to find the most efficient. Antagonism tests were conducted between strains and consortia were formed using all possible combinations in the concentrations of 10(6), 10(7), 10(8) CFU / mL. Qualitative and quantitative determinations of the solubilization of phosphates were performed and considering these results, was prepared a bio-inoculant which was evaluated in plant seeds of grass angleton (Dichantium aristatum) laboratory scale, using a statistical completely randomized design (CRD) with 3 treatments and 5 repetitions: control Treatment 1 seeds; Treatment 2, seeds treated with the consortium of microorganisms selected and Treatment 3, seeds treated with commercial fertilizers DAP and Urea. The parameters, number of leaves, leaf area, plant length, root length and dry weights of all plants, were evaluated. The test results indicated that there is no antagonism inhibition in the growth of the strains tested thus formed consortia which showed greater efficiency phosphorus solubilization, highlighting the consortium of Pantoea sp + Pseudomonas sp at a concentration 10(8)CFU / mL and 5.3 solubilization rates and 842 ppm. In plants showed a significant increase in dry weight and leaf area parameters, indicating greater benefit with respect to the control treatment.