Department of Medicine, University Hospitals Cleveland Medical Center.
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Clin Infect Dis. 2017 Oct 15;65(8):1253-1259. doi: 10.1093/cid/cix559.
Burkholderia cepacia complex (Bcc) are a group of multidrug-resistant gram-negative bacteria rarely reported in patients without cystic fibrosis (CF) or immunocompromising conditions. We investigated Bcc bloodstream infections (BSIs) in a cohort of non-CF patients from the US Veterans Health Administration (VHA).
Using VHA databases, we identified patients with Bcc BSI at facilities nationwide from 1999 through 2015. We ascertained clinical characteristics, treatments, and outcomes and identified factors associated with 30-day mortality in logistic regression analysis.
We identified 248 patients with Bcc BSI, who were of advanced age (mean, 68 years), chronically ill, and had severe disease. The most common sources were central venous catheters (41%) and pneumonia (20%). Most cases were hospital-acquired (155 [62%]) or healthcare-associated (70 [28%]). Mortality at 14, 30, and 90 days was 16%, 25%, and 36%, respectively. Trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolones were active against 94% and 88% of isolates, respectively. Susceptibility to ceftazidime and meropenem occurred in approximately 70% of the isolates. The most prescribed antibiotics were fluoroquinolones (35%), followed by carbapenems (20%), TMP-SMX (18.5%), and ceftazidime (11%). In regression analysis, age (OR, 1.06 [95% confidence interval {CI}, 1.02-1.10], per added year) and the Pitt bacteremia score (OR, 1.65 [95% CI, 1.44-1.94], per unit increase) were associated with higher 30-day mortality.
In this large cohort of BSIs caused by Bcc, cases were mostly hospital-acquired and we observed high mortality, significant resistance to ceftazidime, and limited use of TMP-SMX. These observations add to our understanding of Bcc infection in non-CF patients and highlight the need for interventions to improve their outcome.
洋葱伯克霍尔德菌复合群（Bcc）是一组罕见于无囊性纤维化（CF）或免疫功能低下患者的多药耐药革兰氏阴性菌。我们研究了来自美国退伍军人事务部（VHA）的一组非 CF 患者的 Bcc 血流感染（BSI）。
使用 VHA 数据库，我们确定了 1999 年至 2015 年期间全国各设施中患有 Bcc BSI 的患者。我们确定了临床特征、治疗和结局，并通过逻辑回归分析确定了与 30 天死亡率相关的因素。
我们确定了 248 例 Bcc BSI 患者，这些患者年龄较大（平均 68 岁），患有慢性疾病且病情严重。最常见的来源是中心静脉导管（41%）和肺炎（20%）。大多数病例为医院获得性（155 [62%]）或医疗保健相关（70 [28%]）。14、30 和 90 天的死亡率分别为 16%、25%和 36%。TMP-SMX 和氟喹诺酮对分别对 94%和 88%的分离株具有活性。分离株对头孢他啶和美罗培南的敏感性约为 70%。最常开的抗生素是氟喹诺酮（35%），其次是碳青霉烯类（20%）、TMP-SMX（18.5%）和头孢他啶（11%）。在回归分析中，年龄（OR，1.06 [95%置信区间 {CI}，1.02-1.10]，每增加一年）和 Pitt 菌血症评分（OR，1.65 [95%CI，1.44-1.94]，每增加一个单位）与较高的 30 天死亡率相关。
在本研究中，我们对由 Bcc 引起的大量 BSI 患者进行了研究，结果表明，这些患者大多为医院获得性感染，我们观察到高死亡率、对头孢他啶的显著耐药性以及 TMP-SMX 的使用有限。这些观察结果增加了我们对非 CF 患者中 Bcc 感染的认识，并强调需要采取干预措施来改善他们的预后。
