Skip to main content
Top
Published in: BMC Pulmonary Medicine 1/2018

Open Access 01-12-2018 | Research article

Implementation of a successful eradication protocol for Burkholderia Cepacia complex in cystic fibrosis patients

Authors: Bryan A. Garcia, Jacque L. Carden, Dana L. Goodwin, Tim A. Smith, Amit Gaggar, Kevin Leon, Veena B. Antony, Steven M. Rowe, George M. Solomon

Published in: BMC Pulmonary Medicine | Issue 1/2018

Login to get access

Abstract

Background

Infection with Burkholderia cepacia complex (Bcc) results in a heterogeneous clinical course ranging from asymptomatic colonization of the airways to fulminant respiratory failure in patients with cystic fibrosis (CF). Early eradication of Pseudomonas aeruginosa improves clinical outcomes. The efficacy and clinical outcomes following implementation of an eradication protocol for Bcc are less well understood.

Methods

We developed and implemented a single center Bcc eradication protocol that included an intensive combination of intravenous, inhaled, and oral antibiotic therapies based on in vitro sensitivities. We conducted a retrospective cohort analysis of clinical outcomes compared to patients with chronic Bcc infection.

Results

Six patients were identified as having a newly acquired Bcc colonization and were placed on the eradication protocol. Sequential sputum samples after completion of the protocol demonstrated sustained clearance of Bcc in all patients. Lung function and nutritional status remained stable in the year following eradication.

Conclusion

Clearance of Bcc from sputum cultures using a standardized protocol was successful at one year and was associated with clinical stability.
Literature
1.
go back to reference Rommens JM, Iannuzzi MC, Kerem B, Drumm ML, Melmer G, Dean M, Rozmahel R, Cole JL, Kennedy D, Hidaka N, et al. Identification of the cystic fibrosis gene: chromosome walking and jumping. Science. 1989;245:1059–65.CrossRefPubMed Rommens JM, Iannuzzi MC, Kerem B, Drumm ML, Melmer G, Dean M, Rozmahel R, Cole JL, Kennedy D, Hidaka N, et al. Identification of the cystic fibrosis gene: chromosome walking and jumping. Science. 1989;245:1059–65.CrossRefPubMed
2.
go back to reference Balough K, McCubbin M, Weinberger M, Smits W, Ahrens R, Fick R. The relationship between infection and inflammation in the early stages of lung disease from cystic fibrosis. Pediatr Pulmonol. 1995;20:63–70.CrossRefPubMed Balough K, McCubbin M, Weinberger M, Smits W, Ahrens R, Fick R. The relationship between infection and inflammation in the early stages of lung disease from cystic fibrosis. Pediatr Pulmonol. 1995;20:63–70.CrossRefPubMed
3.
go back to reference Ogrinc G, Kampalath B, Tomashefski JF Jr. Destruction and loss of bronchial cartilage in cystic fibrosis. Hum Pathol. 1998;29:65–73.CrossRefPubMed Ogrinc G, Kampalath B, Tomashefski JF Jr. Destruction and loss of bronchial cartilage in cystic fibrosis. Hum Pathol. 1998;29:65–73.CrossRefPubMed
4.
go back to reference Kosorok MR, Zeng L, West SE, Rock MJ, Splaingard ML, Laxova A, Green CG, Collins J, Farrell PM. Acceleration of lung disease in children with cystic fibrosis after pseudomonas aeruginosa acquisition. Pediatr Pulmonol. 2001;32:277–87.CrossRefPubMed Kosorok MR, Zeng L, West SE, Rock MJ, Splaingard ML, Laxova A, Green CG, Collins J, Farrell PM. Acceleration of lung disease in children with cystic fibrosis after pseudomonas aeruginosa acquisition. Pediatr Pulmonol. 2001;32:277–87.CrossRefPubMed
5.
go back to reference Kerem E, Viviani L, Zolin A, MacNeill S, Hatziagorou E, Ellemunter H, Drevinek P, Gulmans V, Krivec U, Olesen H, Group EPRS. Factors associated with fev1 decline in cystic fibrosis: analysis of the ecfs patient registry. Eur Respir J. 2014;43:125–33.CrossRefPubMed Kerem E, Viviani L, Zolin A, MacNeill S, Hatziagorou E, Ellemunter H, Drevinek P, Gulmans V, Krivec U, Olesen H, Group EPRS. Factors associated with fev1 decline in cystic fibrosis: analysis of the ecfs patient registry. Eur Respir J. 2014;43:125–33.CrossRefPubMed
6.
go back to reference Taccetti G, Campana S, Festini F, Mascherini M, Doring G. Early eradication therapy against pseudomonas aeruginosa in cystic fibrosis patients. Eur Respir J. 2005;26:458–61.CrossRefPubMed Taccetti G, Campana S, Festini F, Mascherini M, Doring G. Early eradication therapy against pseudomonas aeruginosa in cystic fibrosis patients. Eur Respir J. 2005;26:458–61.CrossRefPubMed
7.
go back to reference Proesmans M, Vermeulen F, Boulanger L, Verhaegen J, De Boeck K. Comparison of two treatment regimens for eradication of pseudomonas aeruginosa infection in children with cystic fibrosis. J Cyst Fibros. 2013;12:29–34.CrossRefPubMed Proesmans M, Vermeulen F, Boulanger L, Verhaegen J, De Boeck K. Comparison of two treatment regimens for eradication of pseudomonas aeruginosa infection in children with cystic fibrosis. J Cyst Fibros. 2013;12:29–34.CrossRefPubMed
8.
go back to reference Mayer-Hamblett N, Kloster M, Rosenfeld M, Gibson RL, Retsch-Bogart GZ, Emerson J, Thompson V, Ramsey BW. Impact of sustained eradication of new pseudomonas aeruginosa infection on long-term outcomes in cystic fibrosis. Clin Infect Dis. 2015;61:707–15.CrossRefPubMedPubMedCentral Mayer-Hamblett N, Kloster M, Rosenfeld M, Gibson RL, Retsch-Bogart GZ, Emerson J, Thompson V, Ramsey BW. Impact of sustained eradication of new pseudomonas aeruginosa infection on long-term outcomes in cystic fibrosis. Clin Infect Dis. 2015;61:707–15.CrossRefPubMedPubMedCentral
9.
go back to reference Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med. 2003;168:918–51.CrossRefPubMed Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med. 2003;168:918–51.CrossRefPubMed
10.
go back to reference Frangolias DD, Mahenthiralingam E, Rae S, Raboud JM, Davidson AG, Wittmann R, Wilcox PG. Burkholderia cepacia in cystic fibrosis. Variable disease course. Am J Respir Crit Care Med. 1999;160:1572–7.CrossRefPubMed Frangolias DD, Mahenthiralingam E, Rae S, Raboud JM, Davidson AG, Wittmann R, Wilcox PG. Burkholderia cepacia in cystic fibrosis. Variable disease course. Am J Respir Crit Care Med. 1999;160:1572–7.CrossRefPubMed
11.
go back to reference Courtney JM, Dunbar KE, McDowell A, Moore JE, Warke TJ, Stevenson M, Elborn JS. Clinical outcome of burkholderia cepacia complex infection in cystic fibrosis adults. J Cyst Fibros. 2004;3:93–8.CrossRefPubMed Courtney JM, Dunbar KE, McDowell A, Moore JE, Warke TJ, Stevenson M, Elborn JS. Clinical outcome of burkholderia cepacia complex infection in cystic fibrosis adults. J Cyst Fibros. 2004;3:93–8.CrossRefPubMed
12.
go back to reference Ledson MJ, Gallagher MJ, Jackson M, Hart CA, Walshaw MJ. Outcome of burkholderia cepacia colonisation in an adult cystic fibrosis centre. Thorax. 2002;57:142–5.CrossRefPubMedPubMedCentral Ledson MJ, Gallagher MJ, Jackson M, Hart CA, Walshaw MJ. Outcome of burkholderia cepacia colonisation in an adult cystic fibrosis centre. Thorax. 2002;57:142–5.CrossRefPubMedPubMedCentral
13.
go back to reference Horsley A, Webb K, Bright-Thomas R, Govan J, Jones A. Can early burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy? Front Cell Infect Microbiol. 2011;1:18.CrossRefPubMedPubMedCentral Horsley A, Webb K, Bright-Thomas R, Govan J, Jones A. Can early burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy? Front Cell Infect Microbiol. 2011;1:18.CrossRefPubMedPubMedCentral
14.
go back to reference Regan KH, Bhatt J. Eradication therapy for burkholderia cepacia complex in people with cystic fibrosis. Cochrane Database Syst Rev. 2014;10:CD009876. Regan KH, Bhatt J. Eradication therapy for burkholderia cepacia complex in people with cystic fibrosis. Cochrane Database Syst Rev. 2014;10:CD009876.
15.
go back to reference Flume PA, Mogayzel PJ Jr, Robinson KA, Goss CH, Rosenblatt RL, Kuhn RJ, Marshall BC. Clinical practice guidelines for pulmonary therapies C. Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations. Am J Respir Crit Care Med. 2009;180:802–8.CrossRefPubMed Flume PA, Mogayzel PJ Jr, Robinson KA, Goss CH, Rosenblatt RL, Kuhn RJ, Marshall BC. Clinical practice guidelines for pulmonary therapies C. Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations. Am J Respir Crit Care Med. 2009;180:802–8.CrossRefPubMed
16.
go back to reference Ramsay KA, Butler CA, Paynter S, Ware RS, Kidd TJ, Wainwright CE, Bell SC. Factors influencing acquisition of burkholderia cepacia complex organisms in patients with cystic fibrosis. J Clin Microbiol. 2013;51:3975–80.CrossRefPubMedPubMedCentral Ramsay KA, Butler CA, Paynter S, Ware RS, Kidd TJ, Wainwright CE, Bell SC. Factors influencing acquisition of burkholderia cepacia complex organisms in patients with cystic fibrosis. J Clin Microbiol. 2013;51:3975–80.CrossRefPubMedPubMedCentral
17.
go back to reference St Denis M, Ramotar K, Vandemheen K, Tullis E, Ferris W, Chan F, Lee C, Slinger R, Aaron SD. Infection with burkholderia cepacia complex bacteria and pulmonary exacerbations of cystic fibrosis. Chest. 2007;131:1188–96.CrossRefPubMed St Denis M, Ramotar K, Vandemheen K, Tullis E, Ferris W, Chan F, Lee C, Slinger R, Aaron SD. Infection with burkholderia cepacia complex bacteria and pulmonary exacerbations of cystic fibrosis. Chest. 2007;131:1188–96.CrossRefPubMed
18.
go back to reference Kitt H, Lenney W, Gilchrist FJ. Two case reports of the successful eradication of new isolates of burkholderia cepacia complex in children with cystic fibrosis. BMC Pharmacol Toxicol. 2016;17:14.CrossRefPubMedPubMedCentral Kitt H, Lenney W, Gilchrist FJ. Two case reports of the successful eradication of new isolates of burkholderia cepacia complex in children with cystic fibrosis. BMC Pharmacol Toxicol. 2016;17:14.CrossRefPubMedPubMedCentral
19.
go back to reference Ball R, Brownlee KG, Duff AJ, Denton M, Conway SP, Lee TW. Can burkholderia cepacia complex be eradicated with nebulised amiloride and tobi? J Cyst Fibros. 2010;9:73–4.CrossRefPubMed Ball R, Brownlee KG, Duff AJ, Denton M, Conway SP, Lee TW. Can burkholderia cepacia complex be eradicated with nebulised amiloride and tobi? J Cyst Fibros. 2010;9:73–4.CrossRefPubMed
20.
go back to reference Middleton PG, Kidd TJ, Williams B. Combination aerosol therapy to treat burkholderia cepacia complex. Eur Respir J. 2005;26:305–8.CrossRefPubMed Middleton PG, Kidd TJ, Williams B. Combination aerosol therapy to treat burkholderia cepacia complex. Eur Respir J. 2005;26:305–8.CrossRefPubMed
Metadata
Title
Implementation of a successful eradication protocol for Burkholderia Cepacia complex in cystic fibrosis patients
Authors
Bryan A. Garcia
Jacque L. Carden
Dana L. Goodwin
Tim A. Smith
Amit Gaggar
Kevin Leon
Veena B. Antony
Steven M. Rowe
George M. Solomon
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2018
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-018-0594-8

Other articles of this Issue 1/2018

BMC Pulmonary Medicine 1/2018 Go to the issue