title: An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis.
abstract: BACKGROUND
  Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies.
  
  
  METHODS
  We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested.
  
  
  RESULTS
  25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV1 % predicted was 60 %, and mean BMI was 19.5 kg/m(2). The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 %) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection.
  
  
  CONCLUSIONS
  Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection.
authors.affiliation: Department of Respiratory Medicine, The Lyell-McEwin Hospital, Haydown Road, Elizabeth Vale, 5112, South Australia, Australia. james.geake@health.sa.gov.au.
authors.forename: James B
authors.initials: JB
authors.lastname: Geake
authors.affiliation: The Prince Charles Hospital, Rode Road, Chermside, Brisbane, 4032, Australia. david.reid@qimrberghofer.edu.au.|QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, 4006, Australia. david.reid@qimrberghofer.edu.au.
authors.forename: David W
authors.initials: DW
authors.lastname: Reid
authors.affiliation: Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia. bart.currie@menzies.edu.au.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
authors.affiliation: The Prince Charles Hospital, Rode Road, Chermside, Brisbane, 4032, Australia. scott.bell@qld.health.gov.au.|QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, 4006, Australia. scott.bell@qld.health.gov.au.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Bell
authors.forename: Rowland
authors.initials: R
authors.lastname: Bright-Thomas
authors.forename: Jane
authors.initials: J
authors.lastname: Dewar
authors.forename: Steve
authors.initials: S
authors.lastname: Holden
authors.forename: Nicholas
authors.initials: N
authors.lastname: Simmonds
authors.forename: Khin
authors.initials: K
authors.lastname: Gyi
authors.forename: Dervla
authors.initials: D
authors.lastname: Kenna
authors.forename: Valerie
authors.initials: V
authors.lastname: Waters
authors.forename: Mary
authors.initials: M
authors.lastname: Jackson
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taccetti
authors.forename: John
authors.initials: J
authors.lastname: Kolbe
authors.forename: Mark
authors.initials: M
authors.lastname: O'Carroll
authors.forename: Dee
authors.initials: D
authors.lastname: Campbell
authors.forename: Mirjana
authors.initials: M
authors.lastname: Jaksic
authors.forename: Naghmeh
authors.initials: N
authors.lastname: Radhakrishna
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kidd
authors.forename: William
authors.initials: W
authors.lastname: Flight
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044362:Australasia / Q000453:epidemiology; D016957:Burkholderia pseudomallei; D002442:Ceftazidime / Q000627:therapeutic use; D002648:Child; D003550:Cystic Fibrosis / Q000453:epidemiology* / Q000503:physiopathology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000188:drug therapy / Q000453:epidemiology*; D009656:North America / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime