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Burkholderia cephacia

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Burkholderia cepacia  (B. cepacia)

Burkholderia cepacia (B. cepacia) is a gram-negative, motile, non-spore-forming bacterium. It is a species of bacteria within the Burkholderia cepacia complex (Bcc), a group of closely related bacteria that are often associated with respiratory infections, particularly in individuals with chronic lung diseases, such as cystic fibrosis (CF) or chronic obstructive pulmonary disease (COPD). Although B. cepacia can be found in various environmental settings, including soil and water, it is also notorious for its ability to cause severe, often resistant infections in immunocompromised individuals or those with pre-existing lung conditions.

Transmission and Risk Factors

  • Person-to-person: B. cepacia can spread through direct contact or respiratory droplets, particularly in healthcare settings, posing a risk for individuals who are immunocompromised or those with chronic respiratory diseases.
  • Environmental exposure: It is commonly found in soil, water, and moist environments, making it possible for individuals to acquire infections through exposure to contaminated water, soil or surfaces.
  • Healthcare-associated transmission: B. cepacia is often transmitted in hospital settings, especially in intensive care units (ICUs), where exposure to contaminated surfaces, equipment (nebuliser, ventilators), or hands of healthcare workers can facilitate its spread.

Risk Factors

  • CF: This genetic condition leads to thick, sticky mucus in the lungs, creating an environment conducive to bacterial colonisation. B. cepacia is notorious for colonising the lungs of CF patients and can significantly exacerbate respiratory decline.
  • COPD: Patients with COPD are also at increased risk of respiratory infections caused by B. cepacia.
  • Immunocompromised states: Conditions like cancer, organ transplantation, diabetes, and HIV/AIDS make individuals more susceptible to opportunistic infections.
  • – Prolonged hospitalisation or mechanical ventilation: Extended stays in hospitals, particularly those requiring invasive procedures or use of medical devices, increase the likelihood of infection due to exposure to B. cepacia.

Symptoms

The symptoms of Burkholderia cepacia infections depend on the site of infection and the patient’s underlying health status:

  1. Respiratory Infections:
    • In patients with CF or other chronic respiratory conditions, B. cepacia may cause chronic lung colonisation, which can worsen the patient’s condition.
    • Symptoms include persistent cough, increased sputum production, dyspnoea, wheezing, and in more severe cases, acute pulmonary exacerbations or pneumonia.
  • cepacia can also lead to the development of “cepacia syndrome,” which is characterised by rapid deterioration of respiratory function, fever, increased sputum, and sepsis-like symptoms, particularly in CF patients.
  1. Systemic Infections:
  • In immunocompromised individuals, B. cepacia may lead to bacteraemia, causing fever, chills, and signs of sepsis. If untreated, it can lead to septic shock and organ failure.
  • cepacia is associated with more severe infections in patients with conditions such as cancer, diabetes, and those undergoing organ transplantation.
  1. Urinary Tract and Wound Infections:
  • Though less common, B. cepacia can also cause urinary tract infections, particularly in patients with indwelling catheters or those who are hospitalised for long periods.
  • Soft tissue infections and surgical site infections can occur, particularly in individuals who have undergone invasive procedures.

Diagnosis

  • Microbiological Culture: The gold standard, requiring selective media and extended incubation due to slow growth.
  • PCR: A faster method for detecting cepacia DNA and identifying specific strains, which is crucial for appropriate treatment.
  • Antimicrobial Susceptibility Testing: Essential due to cepacia’s resistance to many antibiotics.
  • Imaging: Chest X-rays or CT scans may be used to assess lung involvement, especially in pneumonia or exacerbations.

Treatment

  • Antibiotics: Treatment often requires combination therapy, as B. cepacia is resistant to many common antibiotics. Options include:
    • Beta-lactams (e.g., ticarcillin-clavulanate, ceftazidime), though resistance is common.
    • Carbapenems (e.g., meropenem) for multidrug-resistant strains.
    • Trimethoprim-sulfamethoxazole (TMP-SMX) for less severe infections.
    • Polymyxins (e.g., polymyxin B) for resistant cases.
    • Severe cases may require a combination of beta-lactams, aminoglycosides, or fluoroquinolones.
  • Supportive Care: Mechanical ventilation or oxygen therapy may be necessary in severe respiratory cases, and hospitalization is crucial for septic patients.

Prevention

  • Infection Prevention and Control (IPC): Strict IPC protocols, including standard precautions and combine contact and direct deposition precautions, isolation, environmental cleaning/disinfection, and disinfection/sterilisation of medical equipment, are essential in healthcare settings.
  • Environmental Control: Patients, particularly those with CF, should avoid exposure to contaminated water and soil, and respiratory devices should be cleaned thoroughly.
  • Patient Education: Training patients on proper hygiene and device cleaning is key to reducing infection risk.
  • Surveillance: Ongoing monitoring and reporting of cases

 

References:

  • (April 11 2024). About Burkholderia cepacia complex. Viewed 18 Feb 2025: https://www.cdc.gov/b-cepacia/about/index.html
  • (2019). Guideline Australian Guidelines for the Prevention and Control of Infection in Healthcare. Viewed 18 Feb 2025: https://www.safetyandquality.gov.au/sites/default/files/2024-08/australian-guidelines-for-the-prevention-and-control-of-infection-in-healthcare.pdf
  • Saiman L,. Siegel J D,. LiPuma J J,. Brown R F,. Bryson E A., Chambers M J,. Downer V S,. Fliege J,. Hazle L A,. Jain M,. Marshall B C,. O’Malley C,. Pattee S R,. Potter-Bynoe G,. Reid S,. Robinson K A,. Sabadosa K A,. Schmidt H J,. Tullis E,. Webber J,. Weber D J. (2014). The 2013 guidelines for infection prevention and control (IPC) for cystic fibrosis. Infection Control Hospital Epidemioly.;35 Suppl 1:S1-S67.PMID: 25025126
  • Sfeir M, M. (2018). Burkholderia cepacia complex infections: More complex than the bacterium name suggest. Jornal of Infection;77(3):166-170. doi: 10.1016/j.jinf.2018.07.006. Epub 2018 Jul 24.
  • Shaban R,. Sotomayer-Castillo C,. Nahidi S,. Li C,. Macbeth D,. Mitchell, B, and Russo P. (2020). Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: An integrative review. Infection Control & Hospital Epidemiology , Volume 41 , Issue 7 , pp. 777 – 78. DOI: https://doi.org/10.1017/ice.2020.184