Significance of airway colonization by Burkholderia gladioli in lung transplant candidates

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes

Pseudomonas and Burkholderia are gram-negative organisms that achieve colonization within the lungs of patients with cystic fibrosis, and are associated with accelerated pulmonary function decline. Multidrug resistance is a hallmark of these organisms, which makes eradication efforts difficult. Furthermore, the literature has outlined increased morbidity and mortality for lung transplant (LTx) recipients infected with these bacterial genera. Indeed, many treatment centers have considered Burkholderia cepacia infection an absolute contraindication to LTx. Ongoing research has delineated different species within the B. cepacia complex (BCC), with significantly varied morbidity and survival profiles. This review considers the current evidence for LTx outcomes between the different subspecies encompassed within these genera as well as prophylactic and management options. The availability of meta-genomic tools will make differentiation between species within these groups easier in the future, and will allow more evidence-based decisions to be made regarding suitability of candidates colonized with these resistant bacteria for LTx. This review suggests that based on the current evidence, not all species of BCC should be considered contraindications to LTx, going forward.

Peritonitis due to Burkholderia gladioli

We report a case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. Burkholderia gladioli, as a plant pathogen, were cultured from peritoneal effluent. Peritonitis healed after intraperitoneal cefazolin and gentamicin. This case indicated that CAPD effluent may be contaminated by B. gladioli, causing CAPD-related peritonitis. On the other hand, it can be successfully treated with intraperitoneal antimicrobials without removal of the Tenckhoff catheter.

Advances in Lung Transplantation for Patients Who Have Cystic Fibrosis

Transplantation in patients who have cystic fibrosis (CF) presents important challenges regarding candidate selection and preoperative management, technical obstacles in the perioperative period, the postoperative management of medical comorbidities related to CF, and the psychosocial impact of transplantation. This article outlines some of these challenges and describes recent advances in approaching this endeavor in patients who have CF.

Burkholderia gladioli: five year experience in a cystic fibrosis and lung transplantation center

BACKGROUND

The impact of infection with Burkholderia gladioli in cystic fibrosis, other chronic airway diseases and immunosuppressed patients is unknown.

METHODS

A six-year retrospective review of all patients with B. gladioli infection was performed in a tertiary referral center with cystic fibrosis and lung transplantation programs. In addition, a targeted survey of all 251 lung transplant recipients was performed. Available B. gladioli isolates were analyzed via pulsed field gel electrophoresis.

RESULTS

Thirty-five patients were culture positive for B. gladioli, including 33 CF patients. No bacteremia was identified. Isolates were available in 18 patients and all were genetically distinct. Two-thirds of these isolates were susceptible to usual anti-pseudomonal antibiotics. After acquisition, only 40% of CF patients were chronically infected (> or =2 positive cultures separated by at least 6 months). Chronic infection was associated with resistance to > or =2 antibiotic groups on initial culture and failure of eradication after antibiotic therapy. The impact of acquisition of B. gladioli infection in chronic infection was variable. Three CF patients with chronic infection underwent lung transplantation. One post-transplant patient developed a B. gladioli mediastinal abscess, which was treated successfully.

CONCLUSIONS

The majority of patients' culture positive for B. gladioli at our center have CF. B. gladioli infection is often transient and is compatible with satisfactory post-lung transplantation outcomes.

Burkholderia gladioli: recurrent abscesses in a patient with cystic fibrosis

We describe a case of an adult patient with cystic fibrosis who developed chronic pulmonary infection and multiple episodes of soft tissue abscesses with Burkholderia gladioli; this organism should be added to the list of potential pathogens for individuals with cystic fibrosis.