Burkholderia cepacia Exit-Site Infection in Peritoneal Dialysis Patients-Clinical Characteristics and Treatment Outcomes.
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Burkholderia cepacia is a hardy bacterium with intrinsic resistance to multiple antibiotics and high transmissibility. Opportunistic healthcare-associated B. cepacia infections among immunocompromised or critically ill patients have been reported, but there is limited data on the clinical characteristics and treatment outcomes of exit-site infection (ESI) in peritoneal dialysis (PD) patients. ♦



Patients who suffered from B. cepacia ESI from 1 January 2004 to 31 December 2014 were reviewed. The clinical characteristics and treatment outcomes of the patients and the antibiotic susceptibility patterns of the bacterial isolates were analyzed. ♦



Twenty-two patients were included for analysis. Eight patients (36.4%) had medical conditions which impaired host immunity, while 7 (31.8%) had pre-existing skin abnormalities. Three patients (13.6%) progressed to tunnel-tract infection and another 3 patients (13.6%) developed associated peritonitis. Fifteen patients (68.2%) responded to medical treatment while 7 (31.8%) required catheter removal. Eleven patients (50.0%) had recurrent B. cepacia ESI, which occurred at 7.8 months (95% confidence interval [CI] 0.1 - 19.4 months) after the first episode. Most B. cepacia strains were susceptible to ceftazidime (95.5%), piperacillin/tazobactam (95.5%), and piperacillin (90.9%). Besides aminoglycosides (80 - 100%), high rates of resistance were also observed for ticarcillin/clavulanate (90.9%). ♦



Burkholderia cepacia ESI is associated with low rates of tunnel-tract infection or peritonitis, but the risk of recurrence is high. Most cases can be managed with medical treatment alone, although one third of patients might require catheter removal.
Nephrology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong desmondy@hku.hk.
Desmond Y H
DY
Yap
Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Jasper F W
JF
Chan
Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong.
Terence
T
Yip
Nephrology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Maggie M Y
MM
Mok
Nephrology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Lorraine P Y
LP
Kwan
Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong.
Wai Kei
WK
Lo
Nephrology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Tak Mao
TM
Chan
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019121:Burkholderia Infections / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D016956:Burkholderia cepacia; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002408:Catheters, Indwelling / Q000009:adverse effects; D020878:Device Removal; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Burkholderia cepacia; exit-site infection; peritoneal dialysis