Mortalidad en niños con bacteriemia por Burkholderia cepacia: una revisión sistemática / Mortality in children with bacteremia due to Burkholderia cepacia: a systematic review

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.

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.