FROM CLINICAL INFECTIOUS DISEASES
Non–cystic fibrosis–related Burkholderia cepacia complexinfections occurred almost exclusively in older hospitalized patients with serious comorbidities – and the majority were acquired in a health care setting, a large U.S. Veterans Health Administration database study has determined.
Despite the bacteria’s tendency to be multidrug-resistant, both fluoroquinolones and trimethoprim-sulfamethoxazole were equally effective, as long as they were promptly initiated, Nadim G. El Chakhtoura, MD, and colleagues reported ( Clin Infect Dis, 2017. doi: 10.1093/cid/cix559 ).
“We consider that the approach to improve survival in B. cepacia complex (Bcc) bloodstream infections … should include controlling the source of infection and prompt initiation of effective antibiotic therapy,” wrote Dr. El Chakhtoura of Cleveland Hospitals University Medical Center, and associates.
The bacteria most often appear as an opportunistic infection in patients with cystic fibrosis, and there are few data about their occurrence in those without the chronic lung disease. Dr. El Chakhtoura and associates’ review spanned more than 1,000 VA hospitals, clinics, and long-term care facilities from 1999 to 2015.
They found 248 cases of Bcc blood infections among such patients. Most (98%) were older men (mean age 68 years) with serious chronic and acute illnesses. Diabetes was common (44%), as was hemodialysis (23%). Many (41%) had been on mechanical ventilation. The etiology of the infections reflected these clinical factors: Most (62%) were nosocomial, with 41% associated with a central venous line and 20% with pneumonia. Just 9% were community acquired, mostly associated with pneumonia and intravenous drug use.
About 85% of isolates underwent antibiotic susceptibility testing. Most (94%) were sensitive to sulfamethoxazole/trimethoprim and 88% to levofloxacin. The next best choices were ceftazidime (72%) and meropenem (69%), although the authors pointed out that only 32 isolates were tested for that drug. Of the 60 tested for ticarcillin-clavulanate, 6% were sensitive.
The authors pointed out that the approximate 30% resistance rate to ceftazidime was concerning and unexpected.
Empiric therapy was considered inappropriate in 35%, and definitive therapy inappropriate in 11%. Having an infectious disease specialist involved with the case increased the chance that it would be treated appropriately (75% vs. 57%). Mortality was 16% at 14 days, 25% at 30 days, and 36% at 90 days. Older age, higher Charlson comorbidity index, higher Pitt bacteremia scores, and prior antibiotic treatment were independently associated with an increased risk of death, the researchers said.
Although the VA database comprises mostly of males, the review spanned so many years and comprised such a large cohort that the findings can probably be accurately extrapolated to a general population of patients, Dr. El Chakhtoura and associates added.
Dr. El Chakhtoura had no relevant financial disclosures.
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