title: Burkholderia species infections in patients with cystic fibrosis in British Columbia, Canada. 30 years' experience.
abstract: BACKGROUND
  We have been collecting Burkholderia species bacteria from patients with cystic fibrosis (CF) for the last 30 years. During this time, our understanding of their multispecies taxonomy and infection control has evolved substantially.
  
  
  OBJECTIVE
  To evaluate the long-term (30 year) epidemiology and clinical outcome of Burkholderia infection in CF, and fully define the risks associated with infection by each species.
  
  
  METHODS
  Isolates from Burkholderia-positive patients (n=107) were speciated and typed annually for each infected patient. Microbiological and clinical data were evaluated by thorough review of patient charts, and statistical analyses performed to define significant epidemiological factors.
  
  
  RESULTS
  Before 1995, the majority of new Burkholderia infections were caused by epidemic clones of Burkholderia cenocepacia. After implementation of new infection control measures in 1995, Burkholderia multivorans became the most prevalent species. Survival analysis showed that patients with CF infected with B. cenocepacia had a significantly worse outcome than those with B. multivorans, and a novel finding was that, after Burkholderia infection, the prognosis for females was significantly worse than for males.
  
  
  CONCLUSIONS
  B. multivorans and B. cenocepacia have been the predominant Burkholderia species infecting people with CF in Vancouver. The implementation of infection control measures were successful in preventing new acquisition of epidemic strains of B. cenocepacia, leaving nonclonal B. multivorans as the most prevalent species. Historically, survival after infection with B. cenocepacia has been significantly worse than B. multivorans infection, and, of new significance, we show that females tend toward worse clinical outcomes.
authors.affiliation: 1 Centre for Understanding and Preventing Infection in Children/Department of Pediatrics, Faculty of Medicine, and.
authors.forename: James E A
authors.initials: JE
authors.lastname: Zlosnik
authors.forename: Guohai
authors.initials: G
authors.lastname: Zhou
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Henry
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Hird
authors.forename: Eshwar
authors.initials: E
authors.lastname: Mahenthiralingam
authors.forename: Mark A
authors.initials: MA
authors.lastname: Chilvers
authors.forename: Pearce
authors.initials: P
authors.lastname: Wilcox
authors.forename: David P
authors.initials: DP
authors.lastname: Speert
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D019117:Burkholderia / Q000235:genetics / Q000302:isolation & purification*; D019121:Burkholderia Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D004269:DNA, Bacterial
keywords: Burkholderia cepacia complex; Burkholderia gladioli; cystic fibrosis; sex; survival