Can early Burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy?
BACKGROUND
Organisms of the Burkholderia cepacia complex (BCC) are important pathogens in cystic fibrosis (CF). The majority of those who acquire BCC develop chronic infection but it can also result in rapid decline in a significant minority. In addition, chronic infection with Burkholderia cenocepacia in particular is regarded as a contraindication to lung transplantation in many units. Whilst aggressive antibiotic therapy is employed in CF to eradicate Pseudomonas aeruginosa before infection becomes irreversibly established, no formal assessment of such strategies has been previously reported for BCC, despite the apparent widespread adoption of this practice.


METHODS
UK adult CF centers were surveyed about their current approach to new BCC infection. Outcomes of eradication therapy were assessed in patients attending the Manchester Adult CF Center with new BCC isolates between 1st January 2002 and 1st May 2011. Patients with previous infection with the same strain of BCC were excluded. BCC were identified at the national reference laboratories and confirmed by species-specific PCR and RecA sequencing.


RESULTS
Routine use of therapies to attempt eradication of new BCC is commonly used in the UK (12/17 centers who responded). This typically involves a combination of intravenous and nebulised antibiotics. Of 19 eligible cases of new BCC infection, the organism has been eradicated in 7 (37%). Three of these did not receive specific eradication therapy. Of 14 patients who have received eradication therapy and completed follow up, BCC were cleared in only 4 (29%).


CONCLUSIONS
Attempted eradication of new BCC is a common practice in UK adult CF centers. A minority of patients clear the infection spontaneously and the effects of eradication therapies are at best modest. Early treatment may be associated with better outcomes, though there are insufficient data to support the use of any specific treatment regimen. A prospective, systematic evaluation of treatments and outcomes is required.
Manchester Adult Cystic Fibrosis Center, University Hospitals South Manchester Manchester, UK; Respiratory Research Group, School of Translational Medicine, University of Manchester, Manchester, UK. alexander.horsley@manchester.ac.uk
Alex
A
Horsley
Kevin
K
Webb
Rowland
R
Bright-Thomas
John
J
Govan
Andrew
A
Jones
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019121:Burkholderia Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D042602:Burkholderia cepacia complex; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications*; D003625:Data Collection; D006801:Humans; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D055502:Secondary Prevention; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents