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{{cs1 config|name-list-style=vanc}}
{{Short description|Species of bacterium}}
{{Short description|Species of bacterium}}
{{DISPLAYTITLE:''Burkholderia cepacia'' complex}}
{{DISPLAYTITLE:''Burkholderia cepacia'' complex}}
{{Confusing|date=October 2023|reason=Confuses the complex (which is described by text) with the species (which is described by the infobox)|talk=Talk:Burkholderia cepacia complex#B. cepacia}}
{{Confusing|date=October 2023|reason=it confuses the complex (which is described by text) with the species (which is described by the infobox)|talk=Talk:Burkholderia cepacia complex#B. cepacia}}
{{Use mdy dates|date=May 2015}}
{{Use mdy dates|date=May 2015}}
{{Taxobox
{{Taxobox
| name = ''Burkholderia cepacia'' complex
| name = ''Burkholderia cepacia'' complex
| image = Burkholderia cepacia.jpg
| image = Burkholderia cepacia.jpg
| image_alt = Scanning electron micrograph of Burkholderia cepacia
| domain = [[Bacteria]]
| domain = [[Bacteria]]
| phylum = [[Pseudomonadota]]
| phylum = [[Pseudomonadota]]
Line 12: Line 14:
| familia = [[Burkholderiaceae]]
| familia = [[Burkholderiaceae]]
| genus = ''[[Burkholderia]]''
| genus = ''[[Burkholderia]]''
| species = '''''B. cepacia'' complex'''
| species_complex = '''''B. cepacia'' complex'''
⚫
| binomial = ''Burkholderia cepacia'' complex
⚫
| binomial_authority = (Palleroni and Holmes 1981) <br> Yabuuchi et al. 1993
| type_species = {{Plain list|
⚫
* ATCC 25416<ref>{{Cite web|url=http://www.atcc.org/common/catalog/numSearch/numResults.cfm?atccNum=25416|title=ATCC 25416}}</ref>
⚫
* CCUG 12691 and 13226
⚫
* CFBP 2227
⚫
* CIP 80.24
⚫
* DSM 7288
⚫
* HAMBI 1976
⚫
* ICMP 5796<ref>{{Cite web|url=https://scd.landcareresearch.co.nz/Specimen/ICMP_5796|title=Specimen Details|website=scd.landcareresearch.co.nz}}</ref>
⚫
* JCM 5964
⚫
* LMG 1222
⚫
* NBRC 14074
⚫
* NCCB 76047
⚫
* NCPPB 2993
⚫
* NCTC 10743
⚫
* NRRL B-14810
}}
}}

'''''Burkholderia cepacia'' complex''' ('''BCC''') is a [[species complex]] consisting of '''''Burkholderia cepacia''''' and at least 20 different biochemically similar species of [[Gram-negative]] [[bacteria]]. They are [[catalase]]-producing and [[lactose]]-non[[fermentation (biochemistry)|fermenting]].<ref name=Lipuma_2005>{{cite journal |author=Lipuma J |title=Update on the ''Burkholderia cepacia'' complex |journal=Curr Opin Pulm Med |volume=11 |issue=6 |pages=528–33 |year=2005 |pmid=16217180 |doi=10.1097/01.mcp.0000181475.85187.ed|s2cid=19117513 }}</ref> Members of BCC are opportunistic human pathogens that most often cause [[pneumonia]] in [[immunocompromise]]d individuals with underlying lung disease (such as [[cystic fibrosis]] or [[chronic granulomatous disease]]).<ref name=Mahenthiralingam_2005>{{cite journal |vauthors=Mahenthiralingam E, Urban T, Goldberg J |title=The multifarious, multireplicon ''Burkholderia cepacia'' complex |journal=Nat Rev Microbiol |volume=3 |issue=2 |pages=144–56 |year=2005 |pmid=15643431 |doi=10.1038/nrmicro1085|s2cid=21736359 }}</ref> Patients with sickle-cell [[Hemoglobinopathy|haemoglobinopathies]] are also at risk. The species complex also attacks young [[onion]] and [[tobacco]] plants, and displays a remarkable ability to digest [[oil]].

== Taxonomy ==

{{Speciesbox
|name=Burkholderia cepacia
⚫
|taxon = Burkholderia cepacia
⚫
| binomial_authority = (Palleroni and Holmes 1981) <br> Yabuuchi et al. 1993
| type_strain =
⚫
* ATCC 25416<ref>{{Cite web|url=http://www.atcc.org/common/catalog/numSearch/numResults.cfm?atccNum=25416|title=ATCC 25416}}</ref>{{efn|Also:
⚫
CCUG 12691 and 13226;
⚫
CFBP 2227;
⚫
CIP 80.24;
⚫
DSM 7288;
⚫
HAMBI 1976;
⚫
ICMP 5796;<ref>{{Cite web|url=https://scd.landcareresearch.co.nz/Specimen/ICMP_5796|title=Specimen Details|website=scd.landcareresearch.co.nz}}</ref>
⚫
JCM 5964;
⚫
LMG 1222;
⚫
NBRC 14074;
⚫
NCCB 76047;
⚫
NCPPB 2993;
⚫
NCTC 10743;
⚫
NRRL B-14810}}
| synonyms = *''Pseudomonas cepacia'' <small>Burkholder 1950</small>
| synonyms = *''Pseudomonas cepacia'' <small>Burkholder 1950</small>
* ''Pseudomonas multivorans'' <small>Stanier et al. 1966</small>
* ''Pseudomonas multivorans'' <small>Stanier et al. 1966</small>
Line 36: Line 45:
* ''Pseudomonas kingii'' <small>Jonsson 1970</small>
* ''Pseudomonas kingii'' <small>Jonsson 1970</small>
}}
}}
The group includes ''B.&nbsp;cepacia'', ''[[Burkholderia multivorans|B.&nbsp;multivorans]]'', ''[[Burkholderia cenocepacia|B.&nbsp;cenocepacia]]'', ''[[Burkholderia vietnamiensis|B.&nbsp;vietnamiensis]]'', ''[[Burkholderia stabilis|B.&nbsp;stabilis]]'', ''[[Burkholderia ambifaria|B.&nbsp;ambifaria]]'', ''[[Burkholderia dolosa|B.&nbsp;dolosa]]'', ''[[Burkholderia anthina|B.&nbsp;anthina]]'', ''[[Burkholderia pyrrocinia|B.&nbsp;pyrrocinia]]'' and ''[[Burkholderia ubonensis|B.&nbsp;ubonensis]]'', among other species.<ref name=Lipuma_2005/>

== Occurrence ==
BCC is resistant to a number of common disinfectants, specifically [[povidone-iodine]], [[triclosan]], [[chlorohexidine]], [[cetylpyridinium chloride]], and quaternary ammoniums such as [[benzalkonium chloride]]. Concentrations used as preservatives in water-based pharmaceutical products are often not enough to kill BCC or even stop it from proliferating.<ref>{{cite journal |last1=Tavares |first1=M |last2=Kozak |first2=M |last3=Balola |first3=A |last4=Sá-Correia |first4=I |title=Burkholderia cepacia Complex Bacteria: a Feared Contamination Risk in Water-Based Pharmaceutical Products. |journal=Clinical Microbiology Reviews |date=17 June 2020 |volume=33 |issue=3 |doi=10.1128/CMR.00139-19 |pmid=32295766|pmc=7194853 }}</ref> Even higher-concentration versions of these biocides intended for disinfection, such as povidone-iodine solution for wound dressing and benzonium chloride wipes, may harbor live BCC if not sterilized using another method.<ref>{{cite web |title=OTC DRUG Recall of Benzalkonium Chloride Antiseptic Wipes |url=https://health.mo.gov/news/newsitem/uuid/c268e2e5-a113-4c82-8ffb-1e79e6921420 |website=Missouri Health & Senior Services}}</ref><ref>{{cite journal | vauthors = Rose H, Baldwin A, Dowson CG, Mahenthiralingam E | title = Biocide susceptibility of the Burkholderia cepacia complex | journal = The Journal of Antimicrobial Chemotherapy | volume = 63 | issue = 3 | pages = 502–10 | date = March 2009 | pmid = 19153076 | pmc = 2640157 | doi = 10.1093/jac/dkn540 | doi-access = free }}</ref>


'''''Burkholderia cepacia'' complex''' ('''BCC'''), or simply '''''Burkholderia cepacia''''', is a group of [[catalase]]-producing, [[lactose]]-non[[fermentation (biochemistry)|fermenting]], [[Gram-negative]] [[bacteria]] composed of at least 20 different species, including ''B.&nbsp;cepacia'', ''[[Burkholderia multivorans|B.&nbsp;multivorans]]'', ''[[Burkholderia cenocepacia|B.&nbsp;cenocepacia]]'', ''[[Burkholderia vietnamiensis|B.&nbsp;vietnamiensis]]'', ''[[Burkholderia stabilis|B.&nbsp;stabilis]]'', ''[[Burkholderia ambifaria|B.&nbsp;ambifaria]]'', ''[[Burkholderia dolosa|B.&nbsp;dolosa]]'', ''[[Burkholderia anthina|B.&nbsp;anthina]]'', ''[[Burkholderia pyrrocinia|B.&nbsp;pyrrocinia]]'' and ''[[Burkholderia ubonensis|B.&nbsp;ubonensis]]''.<ref name=Lipuma_2005>{{cite journal |author=Lipuma J |title=Update on the ''Burkholderia cepacia'' complex |journal=Curr Opin Pulm Med |volume=11 |issue=6 |pages=528–33 |year=2005 |pmid=16217180 |doi=10.1097/01.mcp.0000181475.85187.ed|s2cid=19117513 }}</ref> ''B.&nbsp;cepacia'' is an opportunistic human pathogen that most often causes [[pneumonia]] in [[immunocompromise]]d individuals with underlying lung disease (such as [[cystic fibrosis]] or [[chronic granulomatous disease]]).<ref name=Mahenthiralingam_2005>{{cite journal |vauthors=Mahenthiralingam E, Urban T, Goldberg J |title=The multifarious, multireplicon ''Burkholderia cepacia'' complex |journal=Nat Rev Microbiol |volume=3 |issue=2 |pages=144–56 |year=2005 |pmid=15643431 |doi=10.1038/nrmicro1085|s2cid=21736359 }}</ref> Patients with sickle-cell [[Hemoglobinopathy|haemoglobinopathies]] are also at risk. The species complex also attacks young [[onion]] and [[tobacco]] plants, and displays a remarkable ability to digest [[oil]]. ''Burkholderia cepacia'' is also found in marine environments ([[Sponge|marine sponges]]) and some strains of ''Burkholderia cepacia'' can tolerate high salinity.<ref name=":1">{{Cite journal|last1=Paul|first1=Sulav Indra|last2=Rahman|first2=Md. Mahbubur|last3=Salam|first3=Mohammad Abdus|last4=Khan|first4=Md. Arifur Rahman|last5=Islam|first5=Md. Tofazzal|date=December 2021|title=Identification of marine sponge-associated bacteria of the Saint Martin's island of the Bay of Bengal emphasizing on the prevention of motile Aeromonas septicemia in Labeo rohita|url=http://dx.doi.org/10.1016/j.aquaculture.2021.737156|journal=Aquaculture|volume=545|pages=737156|doi=10.1016/j.aquaculture.2021.737156|issn=0044-8486}}</ref> S.I. Paul et al. (2021)<ref name=":1" /> isolated and biochemically characterized salt tolerant strains of ''Burkholderia cepacia'' from marine sponges of [[St. Martin's Island|Saint Martin's Island]] of the [[Bay of Bengal]], [[Bangladesh]].<ref name=":1" />
''Burkholderia cepacia'' is also found in marine environments ([[Sponge|marine sponges]]) and some strains of ''Burkholderia cepacia'' can tolerate high salinity.<ref name=":1">{{Cite journal|last1=Paul|first1=Sulav Indra|last2=Rahman|first2=Md. Mahbubur|last3=Salam|first3=Mohammad Abdus|last4=Khan|first4=Md. Arifur Rahman|last5=Islam|first5=Md. Tofazzal|date=December 2021|title=Identification of marine sponge-associated bacteria of the Saint Martin's island of the Bay of Bengal emphasizing on the prevention of motile Aeromonas septicemia in Labeo rohita|url=http://dx.doi.org/10.1016/j.aquaculture.2021.737156|journal=Aquaculture|volume=545|pages=737156|doi=10.1016/j.aquaculture.2021.737156|bibcode=2021Aquac.54537156P |issn=0044-8486}}</ref> S.I. Paul et al. (2021)<ref name=":1" /> isolated and biochemically characterized salt tolerant strains of ''Burkholderia cepacia'' from marine sponges of [[St. Martin's Island|Saint Martin's Island]] of the [[Bay of Bengal]], [[Bangladesh]].<ref name=":1" />


== Human infection ==
==Pathogenesis==
===Pathogenesis===
BCC organisms are typically found in water and soil and can survive for prolonged periods in moist environments. They show a relatively poor [[virulence]]. Virulence factors include adherence to plastic surfaces (including those of medical devices) and production of several enzymes such as [[elastase]] and [[gelatinase]]. Also relevant might be their ability to survive attacks from [[neutrophils]].<ref>{{cite book |first1=E. |last1=Torok |first2=E. |last2=Moran |first3=F |last3=Cooke |title=Oxford Handbook of Infectious Diseases and Microbiology |date=2009 |publisher=Oxford University Press |isbn=978-0-19-856925-1}}</ref>
BCC organisms are typically found in water and soil and can survive for prolonged periods in moist environments. They show a relatively poor [[virulence]]. Virulence factors include adherence to plastic surfaces (including those of medical devices) and production of several enzymes such as [[elastase]] and [[gelatinase]]. Also relevant might be their ability to survive attacks from [[neutrophils]].<ref>{{cite book |first1=E. |last1=Torok |first2=E. |last2=Moran |first3=F |last3=Cooke |title=Oxford Handbook of Infectious Diseases and Microbiology |date=2009 |publisher=Oxford University Press |isbn=978-0-19-856925-1}}</ref>


Person-to-person spread has been documented; as a result, many hospitals, clinics, and camps have enacted strict isolation precautions for those infected with BCC. Infected individuals are often treated in a separate area from uninfected patients to limit spread, since BCC infection can lead to a rapid decline in [[lung]] function and result in death.<ref>{{Cite book|url=https://www.worldcat.org/oclc/1118693541|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|date=2020|others=John E. Bennett, Raphael Dolin, Martin J. Blaser|isbn=978-0-323-55027-7|edition=9th|location=Philadelphia, PA|pages=954|chapter=Cystic Fibrosis|oclc=1118693541}}</ref>
Person-to-person spread has been documented; as a result, many hospitals, clinics, and camps have enacted strict isolation precautions for those infected with BCC. Infected individuals are often treated in a separate area from uninfected patients to limit spread, since BCC infection can lead to a rapid decline in [[lung]] function and result in death.<ref>{{Cite book|url=https://www.worldcat.org/oclc/1118693541|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|date=2020|others=John E. Bennett, Raphael Dolin, Martin J. Blaser|isbn=978-0-323-55027-7|edition=9th|location=Philadelphia, PA|pages=954|chapter=Cystic Fibrosis|oclc=1118693541}}</ref>


== Diagnosis ==
=== Diagnosis ===
Diagnosis of BCC involves [[microbiological culture|culturing]] the bacteria from clinical specimens, such as [[sputum]] or blood. BCC organisms are naturally resistant to many common [[antibiotics]], including [[aminoglycosides]] and [[polymyxin B]].<ref name=McGowan_2006>{{cite journal |author=McGowan J |title=Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum |journal=Am J Infect Control |volume=34 |issue=5 Suppl 1 |pages=S29–37; discussion S64–73 |year=2006 |pmid=16813979 |doi=10.1016/j.ajic.2006.05.226}}</ref> and this fact is exploited in the identification of the organism. The organism is usually cultured in ''Burkholderia cepacia'' agar (BC agar), which contains [[crystal violet]] and bile salts to inhibit the growth of Gram-positive cocci, and [[ticarcillin]] and [[polymyxin B]] to inhibit the growth of other Gram-negative bacilli. It also contains [[phenol red]] pH indicator which turns pink when it reacts with alkaline byproducts generated by the bacteria when it grows.{{cn|date=July 2022}}
Diagnosis of BCC involves [[microbiological culture|culturing]] the bacteria from clinical specimens, such as [[sputum]] or blood. BCC organisms are naturally resistant to many common [[antibiotics]], including [[aminoglycosides]] and [[polymyxin B]].<ref name=McGowan_2006>{{cite journal |author=McGowan J |title=Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum |journal=Am J Infect Control |volume=34 |issue=5 Suppl 1 |pages=S29–37; discussion S64–73 |year=2006 |pmid=16813979 |doi=10.1016/j.ajic.2006.05.226}}</ref> and this fact is exploited in the identification of the organism. The organism is usually cultured in ''Burkholderia cepacia'' agar (BC agar), which contains [[crystal violet]] and bile salts to inhibit the growth of Gram-positive cocci, and [[ticarcillin]] and [[polymyxin B]] to inhibit the growth of other Gram-negative bacilli. It also contains [[phenol red]] pH indicator which turns pink when it reacts with alkaline byproducts generated by the bacteria when it grows.{{cn|date=July 2022}}


Alternatively, oxidation-fermentation polymyxin-bacitracin-lactose (OFPBL) agar can be used. OFPBL contains [[polymyxin]] (which kills most Gram-negative bacteria, including ''[[Pseudomonas aeruginosa]]'') and [[bacitracin]] (which kills most Gram-positive bacteria and ''[[Neisseria]]'' species).<ref>{{cite book|author=Becton, Dickinson and Company|title=BD Difco and BD BBL Manual: Manual of Microbiological Culture Media|location=Franklin Lakes, New Jersey|publisher=Becton Dickinson|year=2003|pages=422–423}}</ref><ref>{{cite book|title=Remel Technical Manual|chapter=OFPBL agar|location=Lenexa, Kan|publisher=Remel|year=1997}}</ref> It also contains [[lactose]], and organisms such as BCC that do not ferment lactose turn the pH indicator yellow, which helps to distinguish it from other organisms that may grow on OFPBL agar, such as ''[[Candida (genus)|Candida]]'' species, ''[[Pseudomonas fluorescens]]'', and ''[[Stenotrophomonas]]'' species.{{cn|date=August 2022}}
Alternatively, oxidation-fermentation polymyxin-bacitracin-lactose (OFPBL) agar can be used. OFPBL contains [[polymyxin]] (which kills most Gram-negative bacteria, including ''[[Pseudomonas aeruginosa]]'') and [[bacitracin]] (which kills most Gram-positive bacteria and ''[[Neisseria]]'' species).<ref>{{cite book|author=Becton, Dickinson and Company|title=BD Difco and BD BBL Manual: Manual of Microbiological Culture Media|location=Franklin Lakes, New Jersey|publisher=Becton Dickinson|year=2003|pages=422–423}}</ref><ref>{{cite book|title=Remel Technical Manual|chapter=OFPBL agar|location=Lenexa, Kan|publisher=Remel|year=1997}}</ref> It also contains [[lactose]], and organisms such as BCC that do not ferment lactose turn the pH indicator yellow, which helps to distinguish it from other organisms that may grow on OFPBL agar, such as ''[[Candida (genus)|Candida]]'' species, ''[[Pseudomonas fluorescens]]'', and ''[[Stenotrophomonas]]'' species.{{cn|date=August 2022}}


== Treatment ==
=== Treatment ===
Treatment typically includes multiple antibiotics and may include [[ceftazidime]], [[minocycline]], [[piperacillin]], [[meropenem]], [[chloramphenicol]], and [[trimethoprim/sulfamethoxazole]](co-trimoxazole).<ref name=McGowan_2006 /><ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/1118693541|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|date=2020|others=John E. Bennett, Raphael Dolin, Martin J. Blaser|isbn=978-0-323-55027-7|edition=9th|location=Philadelphia, PA|chapter=Stenotrophomonas maltophilia and Burkholderia cepacia Complex|oclc=1118693541}}</ref> Although co-trimoxazole has been generally considered the drug of choice for ''B. cepacia'' infections, ceftazidime, minocycline, piperacillin, and meropenem are considered to be viable alternative options in cases where co-trimoxazole cannot be administered because of hypersensitivity reactions, intolerance, or resistance.<ref>{{cite journal |author1=Avgeri SG |author2=Matthaiou DK |author3=Dimopoulos G |author4=Grammatikos AP |author5=Falagas ME |title=Therapeutic options for ''Burkholderia cepacia'' infections beyond co-trimoxazole: a systematic review of the clinical evidence |journal=Int. J. Antimicrob. Agents |volume=33 |issue=5 |pages=394–404 |date=May 2009 |pmid=19097867 |doi=10.1016/j.ijantimicag.2008.09.010 }}</ref> Newer beta-lactam / beta-lactamase combinations like [[Ceftazidime/avibactam|ceftazidime-avibactam]] or [[Ceftolozane/tazobactam|ceftolozane-tazobactam]] can also be effective.<ref name=":0" /> ''Burkholderia cepacia'' is intrinsically resistant to [[colistin]] and usually resistant to [[aminoglycoside]]s.<ref>{{Cite book|url=https://www.worldcat.org/oclc/1151708870|title=The Sanford guide to antimicrobial therapy 2020|date=2020|others=David N. Gilbert, Henry F. Chambers, Michael S. Saag, Andrew Pavia|isbn=978-1-944272-13-5|edition=50th|location=Sperryville, VA, USA|oclc=1151708870}}</ref>
Treatment typically includes multiple antibiotics and may include [[ceftazidime]], [[minocycline]], [[piperacillin]], [[meropenem]], [[chloramphenicol]], and [[trimethoprim/sulfamethoxazole]](co-trimoxazole).<ref name=McGowan_2006 /><ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/1118693541|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|date=2020|others=John E. Bennett, Raphael Dolin, Martin J. Blaser|isbn=978-0-323-55027-7|edition=9th|location=Philadelphia, PA|chapter=Stenotrophomonas maltophilia and Burkholderia cepacia Complex|oclc=1118693541}}</ref> Although co-trimoxazole has been generally considered the drug of choice for ''B. cepacia'' infections, ceftazidime, minocycline, piperacillin, and meropenem are considered to be viable alternative options in cases where co-trimoxazole cannot be administered because of hypersensitivity reactions, intolerance, or resistance.<ref>{{cite journal |author1=Avgeri SG |author2=Matthaiou DK |author3=Dimopoulos G |author4=Grammatikos AP |author5=Falagas ME |title=Therapeutic options for ''Burkholderia cepacia'' infections beyond co-trimoxazole: a systematic review of the clinical evidence |journal=Int. J. Antimicrob. Agents |volume=33 |issue=5 |pages=394–404 |date=May 2009 |pmid=19097867 |doi=10.1016/j.ijantimicag.2008.09.010 }}</ref> Newer beta-lactam / beta-lactamase combinations like [[Ceftazidime/avibactam|ceftazidime-avibactam]] or [[Ceftolozane/tazobactam|ceftolozane-tazobactam]] can also be effective.<ref name=":0" /> BCC intrinsically resistant to [[colistin]] and usually resistant to [[aminoglycoside]]s.<ref>{{Cite book|url=https://www.worldcat.org/oclc/1151708870|title=The Sanford guide to antimicrobial therapy 2020|date=2020|others=David N. Gilbert, Henry F. Chambers, Michael S. Saag, Andrew Pavia|isbn=978-1-944272-13-5|edition=50th|location=Sperryville, VA, USA|oclc=1151708870}}</ref>


In people with cystic fibrosis, evidence is insufficient about the effectiveness of long-term antibiotic treatment with continuous inhaled [[aztreonam lysine]] (AZLI) in terms of lung function or chest infections.<ref>{{Cite journal |last1=Frost |first1=Freddy |last2=Shaw |first2=Matthew |last3=Nazareth |first3=Dilip |date=2021-12-10 |title=Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |pages=CD013079 |doi=10.1002/14651858.CD013079.pub3 |issn=1469-493X |pmc=8662788 |pmid=34889457}}</ref>
In people with cystic fibrosis, evidence is insufficient about the effectiveness of long-term antibiotic treatment with continuous inhaled [[aztreonam lysine]] (AZLI) in terms of lung function or chest infections.<ref>{{Cite journal |last1=Frost |first1=Freddy |last2=Shaw |first2=Matthew |last3=Nazareth |first3=Dilip |date=2021-12-10 |title=Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |pages=CD013079 |doi=10.1002/14651858.CD013079.pub3 |issn=1469-493X |pmc=8662788 |pmid=34889457}}</ref>
Line 62: Line 76:


==References==
==References==
{{notelist}}
{{Reflist}}
{{Reflist}}


Latest revision as of 04:43, 30 November 2024

Burkholderia cepacia complex
Scanning electron micrograph of Burkholderia cepacia
Scientific classification
Domain:
Bacteria
Phylum:
Pseudomonadota
Class:
Betaproteobacteria
Order:
Burkholderiales
Family:
Burkholderiaceae
Genus:
Burkholderia
Species complex:
B. cepacia complex

Burkholderia cepacia complex (BCC) is a species complex consisting of Burkholderia cepacia and at least 20 different biochemically similar species of Gram-negative bacteria. They are catalase-producing and lactose-nonfermenting.[1] Members of BCC are opportunistic human pathogens that most often cause pneumonia in immunocompromised individuals with underlying lung disease (such as cystic fibrosis or chronic granulomatous disease).[2] Patients with sickle-cell haemoglobinopathies are also at risk. The species complex also attacks young onion and tobacco plants, and displays a remarkable ability to digest oil.

Taxonomy

[edit]

Burkholderia cepacia
Scientific classification Edit this classification
Domain: Bacteria
Phylum: Pseudomonadota
Class: Betaproteobacteria
Order: Burkholderiales
Family: Burkholderiaceae
Genus: Burkholderia
Species:
B. cepacia
Binomial name
Burkholderia cepacia
(Palleroni and Holmes 1981)
Yabuuchi et al. 1993
Type strain
* ATCC 25416[3][a]
Synonyms
  • Pseudomonas cepacia Burkholder 1950
  • Pseudomonas multivorans Stanier et al. 1966
  • Pseudomonas cepacia (ex Burkholder 1950) Palleroni and Holmes 1981
  • Pseudomonas kingii Jonsson 1970

The group includes B. cepacia, B. multivorans, B. cenocepacia, B. vietnamiensis, B. stabilis, B. ambifaria, B. dolosa, B. anthina, B. pyrrocinia and B. ubonensis, among other species.[1]

Occurrence

[edit]

BCC is resistant to a number of common disinfectants, specifically povidone-iodine, triclosan, chlorohexidine, cetylpyridinium chloride, and quaternary ammoniums such as benzalkonium chloride. Concentrations used as preservatives in water-based pharmaceutical products are often not enough to kill BCC or even stop it from proliferating.[5] Even higher-concentration versions of these biocides intended for disinfection, such as povidone-iodine solution for wound dressing and benzonium chloride wipes, may harbor live BCC if not sterilized using another method.[6][7]

Burkholderia cepacia is also found in marine environments (marine sponges) and some strains of Burkholderia cepacia can tolerate high salinity.[8] S.I. Paul et al. (2021)[8] isolated and biochemically characterized salt tolerant strains of Burkholderia cepacia from marine sponges of Saint Martin's Island of the Bay of Bengal, Bangladesh.[8]

Human infection

[edit]

Pathogenesis

[edit]

BCC organisms are typically found in water and soil and can survive for prolonged periods in moist environments. They show a relatively poor virulence. Virulence factors include adherence to plastic surfaces (including those of medical devices) and production of several enzymes such as elastase and gelatinase. Also relevant might be their ability to survive attacks from neutrophils.[9]

Person-to-person spread has been documented; as a result, many hospitals, clinics, and camps have enacted strict isolation precautions for those infected with BCC. Infected individuals are often treated in a separate area from uninfected patients to limit spread, since BCC infection can lead to a rapid decline in lung function and result in death.[10]

Diagnosis

[edit]

Diagnosis of BCC involves culturing the bacteria from clinical specimens, such as sputum or blood. BCC organisms are naturally resistant to many common antibiotics, including aminoglycosides and polymyxin B.[11] and this fact is exploited in the identification of the organism. The organism is usually cultured in Burkholderia cepacia agar (BC agar), which contains crystal violet and bile salts to inhibit the growth of Gram-positive cocci, and ticarcillin and polymyxin B to inhibit the growth of other Gram-negative bacilli. It also contains phenol red pH indicator which turns pink when it reacts with alkaline byproducts generated by the bacteria when it grows.[citation needed]

Alternatively, oxidation-fermentation polymyxin-bacitracin-lactose (OFPBL) agar can be used. OFPBL contains polymyxin (which kills most Gram-negative bacteria, including Pseudomonas aeruginosa) and bacitracin (which kills most Gram-positive bacteria and Neisseria species).[12][13] It also contains lactose, and organisms such as BCC that do not ferment lactose turn the pH indicator yellow, which helps to distinguish it from other organisms that may grow on OFPBL agar, such as Candida species, Pseudomonas fluorescens, and Stenotrophomonas species.[citation needed]

Treatment

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Treatment typically includes multiple antibiotics and may include ceftazidime, minocycline, piperacillin, meropenem, chloramphenicol, and trimethoprim/sulfamethoxazole(co-trimoxazole).[11][14] Although co-trimoxazole has been generally considered the drug of choice for B. cepacia infections, ceftazidime, minocycline, piperacillin, and meropenem are considered to be viable alternative options in cases where co-trimoxazole cannot be administered because of hypersensitivity reactions, intolerance, or resistance.[15] Newer beta-lactam / beta-lactamase combinations like ceftazidime-avibactam or ceftolozane-tazobactam can also be effective.[14] BCC intrinsically resistant to colistin and usually resistant to aminoglycosides.[16]

In people with cystic fibrosis, evidence is insufficient about the effectiveness of long-term antibiotic treatment with continuous inhaled aztreonam lysine (AZLI) in terms of lung function or chest infections.[17]

History

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B. cepacia was discovered by Walter Burkholder in 1949 as the cause of onion skin rot, and first described as a human pathogen in the 1950s.[18] It was first isolated in patients with cystic fibrosis (CF) in 1977, when it was known as Pseudomonas cepacia.[19] In the 1980s, outbreaks of B. cepacia in individuals with CF were associated with a 35% death rate. B. cepacia has a large genome, containing twice the amount of genetic material as E. coli.[citation needed]

See also

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References

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  1. ^ Also: CCUG 12691 and 13226; CFBP 2227; CIP 80.24; DSM 7288; HAMBI 1976; ICMP 5796;[4] JCM 5964; LMG 1222; NBRC 14074; NCCB 76047; NCPPB 2993; NCTC 10743; NRRL B-14810
  1. ^ a b Lipuma J (2005). "Update on the Burkholderia cepacia complex". Curr Opin Pulm Med. 11 (6): 528–33. doi:10.1097/01.mcp.0000181475.85187.ed. PMID 16217180. S2CID 19117513.
  2. ^ Mahenthiralingam E, Urban T, Goldberg J (2005). "The multifarious, multireplicon Burkholderia cepacia complex". Nat Rev Microbiol. 3 (2): 144–56. doi:10.1038/nrmicro1085. PMID 15643431. S2CID 21736359.
  3. ^ "ATCC 25416".
  4. ^ "Specimen Details". scd.landcareresearch.co.nz.
  5. ^ Tavares M, Kozak M, Balola A, Sá-Correia I (June 17, 2020). "Burkholderia cepacia Complex Bacteria: a Feared Contamination Risk in Water-Based Pharmaceutical Products". Clinical Microbiology Reviews. 33 (3). doi:10.1128/CMR.00139-19. PMC 7194853. PMID 32295766.
  6. ^ "OTC DRUG Recall of Benzalkonium Chloride Antiseptic Wipes". Missouri Health & Senior Services.
  7. ^ Rose H, Baldwin A, Dowson CG, Mahenthiralingam E (March 2009). "Biocide susceptibility of the Burkholderia cepacia complex". The Journal of Antimicrobial Chemotherapy. 63 (3): 502–10. doi:10.1093/jac/dkn540. PMC 2640157. PMID 19153076.
  8. ^ a b c Paul SI, Rahman MM, Salam MA, Khan MA, Islam MT (December 2021). "Identification of marine sponge-associated bacteria of the Saint Martin's island of the Bay of Bengal emphasizing on the prevention of motile Aeromonas septicemia in Labeo rohita". Aquaculture. 545: 737156. Bibcode:2021Aquac.54537156P. doi:10.1016/j.aquaculture.2021.737156. ISSN 0044-8486.
  9. ^ Torok E, Moran E, Cooke F (2009). Oxford Handbook of Infectious Diseases and Microbiology. Oxford University Press. ISBN 978-0-19-856925-1.
  10. ^ "Cystic Fibrosis". Mandell, Douglas, and Bennett's principles and practice of infectious diseases. John E. Bennett, Raphael Dolin, Martin J. Blaser (9th ed.). Philadelphia, PA. 2020. p. 954. ISBN 978-0-323-55027-7. OCLC 1118693541.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  11. ^ a b McGowan J (2006). "Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum". Am J Infect Control. 34 (5 Suppl 1): S29–37, discussion S64–73. doi:10.1016/j.ajic.2006.05.226. PMID 16813979.
  12. ^ Becton, Dickinson and Company (2003). BD Difco and BD BBL Manual: Manual of Microbiological Culture Media. Franklin Lakes, New Jersey: Becton Dickinson. pp. 422–423.
  13. ^ "OFPBL agar". Remel Technical Manual. Lenexa, Kan: Remel. 1997.
  14. ^ a b "Stenotrophomonas maltophilia and Burkholderia cepacia Complex". Mandell, Douglas, and Bennett's principles and practice of infectious diseases. John E. Bennett, Raphael Dolin, Martin J. Blaser (9th ed.). Philadelphia, PA. 2020. ISBN 978-0-323-55027-7. OCLC 1118693541.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  15. ^ Avgeri SG, Matthaiou DK, Dimopoulos G, Grammatikos AP, Falagas ME (May 2009). "Therapeutic options for Burkholderia cepacia infections beyond co-trimoxazole: a systematic review of the clinical evidence". Int. J. Antimicrob. Agents. 33 (5): 394–404. doi:10.1016/j.ijantimicag.2008.09.010. PMID 19097867.
  16. ^ The Sanford guide to antimicrobial therapy 2020. David N. Gilbert, Henry F. Chambers, Michael S. Saag, Andrew Pavia (50th ed.). Sperryville, VA, USA. 2020. ISBN 978-1-944272-13-5. OCLC 1151708870.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  17. ^ Frost F, Shaw M, Nazareth D (December 10, 2021). "Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis". The Cochrane Database of Systematic Reviews. 2021 (12): CD013079. doi:10.1002/14651858.CD013079.pub3. ISSN 1469-493X. PMC 8662788. PMID 34889457.
  18. ^ Burkholder WH (1950). "Sour skin, a bacterial rot of onion bulbs". Phytopathology. 40 (1): 115–7.
  19. ^ Lararya-Cuasay LR, Lipstein M, Huang NN (1977). "Pseudomonas cepacia in the respiratory flora of patients with cystic fibrosis". Pediatr Res. 11 (4): 502. doi:10.1203/00006450-197704000-00792.

Further reading

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