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.

Microorganismos involucrados en las infecciones respiratorias de pacientes con fibrosis quísitca / Microorganisms involved in respiratory infections in cystic fibrosis patients

La fibrosis quística es la enfermedad autosómica recesiva letal más frecuente en la infancia. Se caracteriza por presentar una evolución crónica, progresiva y compromiso multisistémico. El objetivo de este trabajo fue conocer la frecuencia de los microorganismos implicados en las infecciones respiratorias de pacientes fibroquísticos atendidos en el Hospital de Pediatría Prof. Dr. Juan P. Garrahan durante el año 2012 y su resistencia a los antimicrobianos. Para la identificación bacteriana se utilizaron pruebas bioquímicas convencionales, sistemas automatizados y semiautomatizados. En la identificación de miembros del complejo Burkholderia cepacia se utilizaron además métodos moleculares. De esta manera se pudo lograr la clasificación genética de las especies incluidas dentro de ese complejo presentes en los pacientes fibroquísticos de nuestro medio. Este trabajo nos permitió conocer la situación microbiológica actual de las infecciones respiratorias en los pacientes fibroquísticos. Tanto el estudio minucioso de los cultivos convencionales como la caracterización molecular de las especies de B. cepacia deben seguirse en los pacientes colonizados por microorganismos multirresistentes y son imprescindibles en el control postratamiento después del aislamiento de estos patógenos (AU)

Cystic fibrosis is the most common lethal autosomal recessive disease in childhood. It is characterized by a chronic, progressive evolution and multisystemic involvement. The aim of this study was to assess the incidence of the microorganisms involved in respiratory infections of patients with cystic fibrosis seen at the Pediatric Hospital Prof. Dr. Juan P. Garrahan in 2012 and their resistance to antimicrobial agents. To identify the microorganisms conventional biochemical tests with automatized and semiautomatized systems were used. For the identification of members of the Burkholderia cepacia complex molecular studies were additionally used. Species of this complex found in cystic fibrosis patients in our setting were genetically classified allowing for the definition of the current microbiological situation of respiratory infections in cystic fibrosis patients. Careful study of conventional cultures as well as molecular typing of the B. cepacia species should be routinely performed in patients colonized by multiresistant microorganisms and is fundamental in the post-treatment monitoring after the isolation of these pathogens (AU)

Bacteremia de curso fatal por burkholderia cepacia: revisión de la literatura a propósito de un caso clínico / Fatal sepsis caused by burkholderia cepacia: case report and brief review

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

Avaliaçäo da contaminaçäo bacteriana em desinfetantes de uso domiciliar / Evaluation of bacterial contamination in disinfectants for domestic use

Objetivo: Avaliar desinfetantes de uso domiciliar, identificando a presença de bactérias contaminantes, e conhecer o nível de tolerância dessas bactérias ao cloreto de benzalcônio. Métodos: Foram adquiridos aleatoriamente no comércio da regiäo metropolitana de Säo Paulo, SP, Brasil, 52 amostras de desinfetantes de uso domiciliar para análise quanto à presença de bactérias contaminantes. O nível de tolerância dessas bactérias ao cloreto de benzalcônio foi determinado pelo método da macrodiluiçäo em caldo. Resultados: De 52 amostras, 16 (30,77 por cento) estavam contaminadas por bactérias Gram negativas, com contagens variando entre 104 e 106 UFC/ml. Esses contaminantes foram identificados como Alcaligenes xylosoxidans, Burkholderia cepacia e Serratia marcescens. As Concentraçöes Inibitórias Mínimas (CIM: mg/ml) do cloreto de benzalcônio para S. marcescens, A. xylosoxidans e B. cepacia foram: 2,48, 1,23 e 0,30, respectivamente. Conclusöes: Os desinfetantes de uso domiciliar a base de compostos de amônio quaternário säo passíveis de contaminaçäo por bactérias. As CIMs do cloreto de benzalcônio para as bactérias contaminantes estavam abaixo das concentraçöes do princípio ativo presente nos desinfetantes, indicando que a tolerância ao biocida näo é estável, podendo ser perdida com o cultivo das bactérias em meios de cultura sem o biocida