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Burkholderia cepacia

The Burkholderia cepacia complex consists of 10 genomic species called genomovars: B. cepacia, B. multivorans, B. cenocepacia, B. vietnamiensis, B. stabilis, B. ambifaria, B. dolosa, B. anthina, B. pyrrocinia and B. pseudomultivorans. These names should now be used in preference to the genomovar number (old genomovar 3 is B. cenocepacia). Identification is difficult and all suspected isolates should be sent to a reference laboratory (Public Health England Laboratory at Colindale) for confirmation. Some strains confer an adverse prognosis (e.g. B. multivorans, B. cenocepacia and B. dolosa) and B. cenocepacia is an exclusion criteria for many transplant programmes because of a survival disadvantage post-surgery.

IV treatment

Eradication should be attempted using iv antibiotics. The choice depends on sensitivities and is usually a combination of a drugs from Group 1 and Group 2 in the following table:

IV cotrimoxazole may also be used in combination with these drugs. Where there is failure to respond and clinical deterioration combined with pan resistance to the regular B.cepacia antibitoics, Temocillin can be considered. This drug is only held at the adult CF unit at the Churchill hospital. For further details on its use, click here. It can be used with meropenem, ciprofloxacin or tobramycin.

Chronic infection

B. cepacia complex bacteria are uniformly resistant to colistin. The choice of suppressive therapy is between nebulised ceftazidime, meropenem, tobramycin, aztreonam lysine or temocillin depending on antibiotic sensitivity and tolerability. Long term oral therapy may be considered including doxycycline. Oral trimethoprim or co-trimoxazole can be helpful for minor exacerbations in a chronically infected patient.