Zlosnik James E A, Zhou Guohai, Brant Rollin, Henry Deborah A, Hird Trevor J, Mahenthiralingam Eshwar, Chilvers Mark A, Wilcox Pearce, Speert David P
1 Centre for Understanding and Preventing Infection in Children/Department of Pediatrics, Faculty of Medicine, and.
Ann Am Thorac Soc. 2015 Jan;12(1):70-8. doi: 10.1513/AnnalsATS.201408-395OC.
We have been collecting Burkholderia species bacteria from patients with cystic fibrosis (CF) for the last 30 years. During this time, our understanding of their multispecies taxonomy and infection control has evolved substantially.
To evaluate the long-term (30 year) epidemiology and clinical outcome of Burkholderia infection in CF, and fully define the risks associated with infection by each species.
Isolates from Burkholderia-positive patients (n=107) were speciated and typed annually for each infected patient. Microbiological and clinical data were evaluated by thorough review of patient charts, and statistical analyses performed to define significant epidemiological factors.
Before 1995, the majority of new Burkholderia infections were caused by epidemic clones of Burkholderia cenocepacia. After implementation of new infection control measures in 1995, Burkholderia multivorans became the most prevalent species. Survival analysis showed that patients with CF infected with B. cenocepacia had a significantly worse outcome than those with B. multivorans, and a novel finding was that, after Burkholderia infection, the prognosis for females was significantly worse than for males.
B. multivorans and B. cenocepacia have been the predominant Burkholderia species infecting people with CF in Vancouver. The implementation of infection control measures were successful in preventing new acquisition of epidemic strains of B. cenocepacia, leaving nonclonal B. multivorans as the most prevalent species. Historically, survival after infection with B. cenocepacia has been significantly worse than B. multivorans infection, and, of new significance, we show that females tend toward worse clinical outcomes.
在过去30年里，我们一直在收集囊性纤维化（CF）患者的伯克霍尔德菌属细菌。在此期间，我们对其多物种分类和感染控制的理解有了显著进展。
评估CF患者伯克霍尔德菌感染的长期（30年）流行病学情况和临床结局，并全面确定每种细菌感染相关的风险。
每年对伯克霍尔德菌阳性患者（n = 107）的分离株进行菌种鉴定和分型。通过全面查阅患者病历评估微生物学和临床数据，并进行统计分析以确定重要的流行病学因素。
1995年前，大多数新的伯克霍尔德菌感染由洋葱伯克霍尔德菌的流行克隆株引起。1995年实施新的感染控制措施后，多食伯克霍尔德菌成为最常见的菌种。生存分析表明，感染洋葱伯克霍尔德菌的CF患者结局明显比感染多食伯克霍尔德菌的患者差，一项新发现是，伯克霍尔德菌感染后，女性的预后明显比男性差。
多食伯克霍尔德菌和洋葱伯克霍尔德菌一直是温哥华感染CF患者的主要伯克霍尔德菌属菌种。感染控制措施的实施成功预防了洋葱伯克霍尔德菌流行菌株的新感染，使非克隆性的多食伯克霍尔德菌成为最常见的菌种。从历史上看，感染洋葱伯克霍尔德菌后的生存率明显低于感染多食伯克霍尔德菌，而且，具有新意义的是，我们发现女性的临床结局往往更差。
