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Management and outcomes of Burkholderia cepacia complex bacteremia in patients without cystic fibrosis: a retrospective observational study.
Eur J Clin Microbiol Infect Dis. 2020 Jun 25 [Online ahead of print]EJ

Abstract

Burkholderia cepacia complex (BCC) is an emerging pathogen of nosocomial infection in chronic or critically ill patients without cystic fibrosis (CF). The objective was to evaluate the management and outcomes of BCC bacteremia in patients without CF. We conducted a retrospective study of non-CF adult patients with BCC bacteremia between January 1997 and December 2016 at 4 tertiary hospitals in South Korea. A total of 216 non-CF patients with BCC bacteremia were identified. Most cases were hospital-acquired (79.2%), and the most common source was a central venous catheter (CVC) (42.1%). The rates of susceptibility to trimethoprim-sulfamethoxazole and piperacillin-tazobactam of BCC isolates were high as 92.8% and 90.3%, respectively. The rates of susceptibility to ceftazidime, meropenem, and levofloxacin were 75.5%, 72.3%, and 64.1%, respectively. The 14-day, 30-day, and in-hospital mortality rate was 19.4%, 23.1%, and 31.0%, respectively. Female (OR = 3.1; 95% CI, 1.4-6.8), liver cirrhosis (OR = 6.2; 95% CI, 1.6-16.6), septic shock (OR = 11.2; 95% CI, 5.1-24.8), and catheter-related infection (OR = 2.6, 95% CI, 1.2-5.8) were the independent risk factors for 30-day mortality. The outcome did not differ according to type of antibiotics used. Among 91 patients with CVC-related BCC bacteremia, delayed CVC removal (> 3 days) had a higher rate of persistent bacteremia (54.5 vs. 26.1%; P = 0.03) and lower rate of clinical response (49.0 vs. 71.9%; P = 0.04), compared with early CVC removal (within 3 days). BCC bacteremia occurring in non-CF patients was mostly hospital-acquired and CVC-related. Early removal of the catheter is crucial in treatment of CVC-related BCC bacteremia.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.Department of Internal Medicine, SoonChunHyang University Bucheon Hospital, Bucheon, Republic of Korea.Department of Internal Medicine, SoonChunHyang University Bucheon Hospital, Bucheon, Republic of Korea.Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. thanks1126@hanmail.net.Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea. meesooch@snu.ac.kr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32583228

Citation

Lee, Yu-Mi, et al. "Management and Outcomes of Burkholderia Cepacia Complex Bacteremia in Patients Without Cystic Fibrosis: a Retrospective Observational Study." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 2020.
Lee YM, Park KH, Moon C, et al. Management and outcomes of Burkholderia cepacia complex bacteremia in patients without cystic fibrosis: a retrospective observational study. Eur J Clin Microbiol Infect Dis. 2020.
Lee, Y. M., Park, K. H., Moon, C., Kim, D. Y., Lee, M. S., Kim, T., Choo, E. J., Chong, Y. P., Kim, S. H., Kim, Y. S., Woo, J. H., & Chang, M. S. (2020). Management and outcomes of Burkholderia cepacia complex bacteremia in patients without cystic fibrosis: a retrospective observational study. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. https://doi.org/10.1007/s10096-020-03960-2
Lee YM, et al. Management and Outcomes of Burkholderia Cepacia Complex Bacteremia in Patients Without Cystic Fibrosis: a Retrospective Observational Study. Eur J Clin Microbiol Infect Dis. 2020 Jun 25; PubMed PMID: 32583228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management and outcomes of Burkholderia cepacia complex bacteremia in patients without cystic fibrosis: a retrospective observational study. AU - Lee,Yu-Mi, AU - Park,Ki-Ho, AU - Moon,Chisook, AU - Kim,Dong Youn, AU - Lee,Mi Suk, AU - Kim,Tark, AU - Choo,Eun Ju, AU - Chong,Yong Pil, AU - Kim,Sung-Han, AU - Kim,Yang Soo, AU - Woo,Jun Hee, AU - Chang,Mee Soo, Y1 - 2020/06/25/ PY - 2020/03/23/received PY - 2020/06/18/accepted PY - 2020/6/26/entrez KW - Bacteremia KW - Burkholderia cepacia complex KW - Central venous catheter KW - Outcome KW - Risk factor JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur. J. Clin. Microbiol. Infect. Dis. N2 - Burkholderia cepacia complex (BCC) is an emerging pathogen of nosocomial infection in chronic or critically ill patients without cystic fibrosis (CF). The objective was to evaluate the management and outcomes of BCC bacteremia in patients without CF. We conducted a retrospective study of non-CF adult patients with BCC bacteremia between January 1997 and December 2016 at 4 tertiary hospitals in South Korea. A total of 216 non-CF patients with BCC bacteremia were identified. Most cases were hospital-acquired (79.2%), and the most common source was a central venous catheter (CVC) (42.1%). The rates of susceptibility to trimethoprim-sulfamethoxazole and piperacillin-tazobactam of BCC isolates were high as 92.8% and 90.3%, respectively. The rates of susceptibility to ceftazidime, meropenem, and levofloxacin were 75.5%, 72.3%, and 64.1%, respectively. The 14-day, 30-day, and in-hospital mortality rate was 19.4%, 23.1%, and 31.0%, respectively. Female (OR = 3.1; 95% CI, 1.4-6.8), liver cirrhosis (OR = 6.2; 95% CI, 1.6-16.6), septic shock (OR = 11.2; 95% CI, 5.1-24.8), and catheter-related infection (OR = 2.6, 95% CI, 1.2-5.8) were the independent risk factors for 30-day mortality. The outcome did not differ according to type of antibiotics used. Among 91 patients with CVC-related BCC bacteremia, delayed CVC removal (> 3 days) had a higher rate of persistent bacteremia (54.5 vs. 26.1%; P = 0.03) and lower rate of clinical response (49.0 vs. 71.9%; P = 0.04), compared with early CVC removal (within 3 days). BCC bacteremia occurring in non-CF patients was mostly hospital-acquired and CVC-related. Early removal of the catheter is crucial in treatment of CVC-related BCC bacteremia. SN - 1435-4373 UR - https://www.unboundmedicine.com/medline/citation/32583228/Management_and_outcomes_of_Burkholderia_cepacia_complex_bacteremia_in_patients_without_cystic_fibrosis:_a_retrospective_observational_study L2 - https://dx.doi.org/10.1007/s10096-020-03960-2 DB - PRIME DP - Unbound Medicine ER -
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