ABSTRACT
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.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Lung Transplantation/adverse effects , Burkholderia cepacia/isolation & purification , Burkholderia Infections/etiology , Cystic Fibrosis/microbiology , Phylogeny , Time Factors , Brazil/epidemiology , DNA, Bacterial , Prospective Studies , Regression Analysis , Risk Factors , Lung Transplantation/mortality , Treatment Outcome , Burkholderia Infections/mortality , Cystic Fibrosis/surgery , Cystic Fibrosis/complications , Cystic Fibrosis/mortality , Kaplan-Meier Estimate , Contraindications, Procedure , Intensive Care Units , Length of StayABSTRACT
Las especies del complejo Burkholderia cepacia (CBC) son capaces de causar infecciones crónicas del tracto respiratorio en pacientes con fibrosis quística y en otros individuos inmunocomprometidos. La mayoría de estas especies exhiben alta resistencia a la terapia antibiótica, lo que genera la necesidad de una detección rápida y precisa para poder implementar estrategias de control adecuadas. En este trabajo se utilizó la técnica de reacción en cadena de la polimerasa (PCR) para amplificar el gen recA (PCR-recA), con el fin de identificar microorganismos pertenecientes al CBC. Con este método molecular como referencia, se evaluó la sensibilidad (S) y la especificidad (E) de dos sistemas de identificación comerciales automatizados, VITEK 2 y API 20NE (bioMérieux®), así como también el valor de las pruebas bioquímicas manuales más representativas para la identificación de estos microorganismos. El método VITEK 2 presentó una S del 71,1 % y una E del 100 %; para el método API 20NE, estos valores fueron 69,7 % y 90,2 %, respectivamente. En cuanto a las pruebas fenotípicas manuales, los resultados obtenidos fueron más heterogéneos, lo que posiblemente se deba a que estas bacterias podrían sufrir presión selectiva para sobrevivir en pacientes crónicos y perder factores fenotípicos característicos. La técnica de PCR-recA resultó de fácil implementación, por lo que cabe considerar a esta técnica de identificación como una opción viable, aun en laboratorios de diagnóstico clínico de mediana complejidad.
Species belonging to the Burkholderia cepacia complex (BCC) are capable of causing chronic respiratory tract infections in patients suffering from cystic fibrosis as wel as in immunocompromised individuals. Most of these species are highly resistant to antibiotic therapy, generating the need for their rapid and accurate detection for the proper treatment and clinical management of these patients. In this wok, the polymerase chain reaction (PCR) technique based on the amplification of the recA gene (PCR-recA) was applied for an accurate identification of bacteria belonging to the BCC. Sensitivity (S) and specificity (E) of two biochemically-based commercial automated systems, API 20NE and VITEK 2 (bioMérieux®), and of the most representative biochemical manual tests for the identification of the Burkholderia cepacia complex were herein evaluated. The commercial systems VITEK 2 and API 20NE showed the following sensitivity and specificity vaues for identification to the species level, S: 71.1 %, E: 100 %, S: 69.7 %, E: 90.2 %, respectively. More complex results were observed for phenotypic manual tests, since BCC bacteria can undergo selective pressure to survive in chronic patients causing the loss of their typical phenotypic characteristics. The PCR-recA technique was easy to implement even in medium-complexity clinical diagnostic laboratories.
Subject(s)
Humans , Bacterial Typing Techniques/methods , Burkholderia Infections/microbiology , Burkholderia cepacia complex/isolation & purification , Reagent Kits, Diagnostic , Respiratory Tract Infections/microbiology , Automation , Bacterial Proteins/genetics , Burkholderia Infections/diagnosis , Burkholderia Infections/etiology , Colorimetry/methods , Cystic Fibrosis/complications , Disease Susceptibility , DNA, Bacterial/genetics , Genes, Bacterial , Genotype , Polymerase Chain Reaction/methods , Reference Standards , Reproducibility of Results , Rec A Recombinases/genetics , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/etiology , Sensitivity and Specificity , SoftwareABSTRACT
BACKGROUND: Burkholderia cepacia has been described as a cause of opportunist infections in patients with immune deficiency because of the high transmission rates. Actually the B. cepacia is subdivided in nine different genomic species that show morphological similarity, called genomovars. High mortality rates have been associated with infections caused by genomovars in susceptible patients; antibiotics are not efficient because of the high resistance level and genomic mutability. Little is known about the epidemiological traits of this bacterium; therefore, their isolation remains a relevant technical problem. AIMS: The objective of this review is to describe Burkholderia cepacia as a bacterial complex with high pathogenicity and variability of habitats. MATERIALS AND METHODS: A systematic search was realized using the international bibliographic databanks SCIELO, HIGHWIRE, PUBMED, SCIRUS and LILACS to provide a useful and practical review for the health workers that do not know this microorganism. CONCLUSIONS: Today, B. cepacia complex is a very important problem for the acquired immunodeficiency syndrome and cystic fibrosis patients. The immunodeficiency caused by these diseases is a positive factor for this microorganism to infect and kill these patients. Therefore, this opportunistic pathogen should be pointed out as a risk to these patients and hospitals all over the world must be prepared to detect and combat this bacterium.
Subject(s)
Burkholderia Infections/etiology , Burkholderia cepacia , Comorbidity , Cystic Fibrosis/complications , Humans , Opportunistic Infections/etiology , Prognosis , Risk FactorsABSTRACT
Burkholderia cepacia es un bacilo Gram negativo no fermentador, multiresistente, oportunista en pacientes con fibrosis quística y neutropénicos, generalmente asociado a brotes intrahospitalarios. Se presenta el curso clínico de un preescolar hospitalizado en el Hospital Clínico Regional Valdivia con diagnóstico de neuroblastoma tipo II etapa IV, quien en el último ciclo de quimioterapia presentó una prolongada y severa neutropenia, lo que facilitó la aparición de una bacteremia por B. cepacia de curso fatal. A propósito de este caso se revisa la literatura