title: Misidentification of Burkholderia cepacia in US cystic fibrosis treatment centers: an analysis of 1,051 recent sputum isolates.
abstract: BACKGROUND
  Burkholderia cepacia remains a significant pathogen in persons with cystic fibrosis (CF). The medical and psychosocial consequences of pulmonary colonization with this bacterium are enormous. However, B cepacia may be frequently misidentified from CF sputum culture.
  
  
  OBJECTIVE
  To determine the rate of misidentification of B cepacia recently recovered from CF sputum culture of persons receiving care in US treatment centers.
  
  
  METHODS
  Bacterial isolates cultured from CF sputum and putatively identified as B cepacia or other related nonlactose-fermenting Gram-negative species were referred from participating treatment centers. Isolates underwent polyphasic analyses employing phenotypic (selective media and biochemical testing) and genotypic (polymerase chain reaction) assays to determine species identification. Taxonomic evaluations were performed by using sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins and amplified-fragment length polymorphism analysis.
  
  
  RESULTS
  A total of 1,051 isolates recovered from 608 patients were received from 115 treatment centers in 91 US cities. Among the isolates identified as B cepacia by referring laboratories, 11% could not be confirmed as B cepacia by polyphasic analyses. In addition, 36% of isolates not specifically identified by the referring laboratory or identified as a species other than B cepacia were, in fact, found to be members of the B cepacia complex.
  
  
  CONCLUSIONS
  Rates of misidentification of B cepacia remain unacceptably high among US treatment centers. These data suggest the need for increased awareness of this problem among CF centers and their affiliated laboratories, better adherence to recommended protocols for evaluation of CF sputum, and greater use of reference laboratories equipped to provide advanced analyses.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor 48109-0646, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: McMenamin
authors.forename: T M
authors.initials: TM
authors.lastname: Zaccone
authors.forename: T
authors.initials: T
authors.lastname: Coenye
authors.forename: P
authors.initials: P
authors.lastname: Vandamme
authors.forename: J J
authors.initials: JJ
authors.lastname: LiPuma
mesh_terms: D001431:Bacteriological Techniques; D019121:Burkholderia Infections / Q000175:diagnosis / Q000382:microbiology*; D016956:Burkholderia cepacia; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000382:microbiology*; D003951:Diagnostic Errors; D006801:Humans; D016133:Polymerase Chain Reaction; D013183:Sputum / Q000382:microbiology*; D014481:United States