BURKHOLDERIA CEPACIA: Management Issues and New Insights
Section snippets
Emergence of B. cepacia in Cystic Fibrosis
After its description nearly 50 years ago as the causative agent of onion rot,11 Pseudomonas cepacia was regarded as a plant pathogen with a ubiquitous distribution in the natural environment and a low potential for causing human infection. Sporadic human infections were reported,26, 82, 86 however, as were descriptions of “pseudo-epidemics”6, 25 and true nosocomial infections101, 105 attributable to the use of contaminated disinfectants and anesthetic solutions. CF was occasionally identified
Host Factors
Unfortunately, relatively little is known regarding the factors that allow this otherwise nonpathogenic bacterial species to colonize and infect the CF respiratory tract. Although recent studies have identified a number of putative bacterial virulence factors39 (discussed subsequently), none has yet proven to be critical in the pathogenicity of infection in CF. Even less is understood about the CF host factors involved in B. cepacia infection. Several recent studies have demonstrated features
Identification and Misidentification of B. cepacia
The medical and psychosocial implications of B. cepacia colonization are enormous for individuals with CF. For the CF care provider, accurate identification of this organism from CF sputum underlies patient management and infection control practices. Identification may be problematic and misidentification is relatively common, however; in recent studies, as many as 20% of isolates sent to reference laboratories identified as B. cepacia were misidentified.10, 44, 61 The use of selective media,
How is B. cepacia Transmitted Between Individuals?
Because pulmonary colonization with B. cepacia typically is chronic and infection is refractory to antimicrobial therapy, a major goal of clinical management in CF is the prevention of acquisition of B. cepacia. This goal underlies current infection control policies that limit contact between colonized and noncolonized individuals. Although such policies have been effective in reducing the incidence of B. cepacia infection,69, 113 they have not entirely eliminated B. cepacia acquisition.20
CONCLUSION
The proportion of individuals with CF who become colonized with B. cepacia is relatively small, but this pathogen accounts for considerable morbidity and mortality. Because most clinical isolates exhibit broad-spectrum antibiotic resistance, therapeutic options are limited and prevention of acquisition therefore remains the goal of patient management. Unfortunately, the resultant stringent infection control policies have had a profound impact on the entire CF community. Modification of these
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Address reprint requests to John J. LiPuma, MD, Department of Pediatrics, Allegheny University of the Health Sciences, 3300 Henry Avenue, Philadelphia, PA 19129
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Departments of Pediatrics and Microbiology/Immunology, Allegheny University of the Health Sciences; and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania