Factors influencing acquisition of Burkholderia cepacia complex organisms in patients with cystic fibrosis

Ramsay, Kay A., Butler, Claire A., Paynter, Stuart, Ware, Robert S., Kidd, Timothy J., Wainwright, Claire E. and Bell, Scott C. (2013) Factors influencing acquisition of Burkholderia cepacia complex organisms in patients with cystic fibrosis. Journal of Clinical Microbiology, 51 12: 3975-3980. doi:10.1128/JCM.01360-13

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Author Ramsay, Kay A.
Butler, Claire A.
Paynter, Stuart
Ware, Robert S.
Kidd, Timothy J.
Wainwright, Claire E.
Bell, Scott C.
Title Factors influencing acquisition of Burkholderia cepacia complex organisms in patients with cystic fibrosis
Journal name Journal of Clinical Microbiology   Check publisher's open access policy
ISSN 0095-1137
Publication date 2013-12-01
Year available 2013
Sub-type Article (original research)
DOI 10.1128/JCM.01360-13
Open Access Status File (Publisher version)
Volume 51
Issue 12
Start page 3975
End page 3980
Total pages 6
Place of publication Washington, DC, United States
Publisher American Society for Microbiology
Language eng
Abstract Burkholderia cepacia complex organisms are important transmissible pathogens found in cystic fibrosis (CF) patients. In recent years, the rates of cross-infection of epidemic strains have declined due to effective infection control efforts. However, cases of sporadic B. cepacia complex infection continue to occur in some centers. The acquisition pathways and clinical outcomes of sporadic B. cepacia complex infection are unclear. We sought to determine the patient clinical characteristics, outcomes, incidence, and genotypic relatedness for all cases of B. cepacia complex infection at two CF centers. We also sought to study the external conditions that influence the acquisition of infection. From 2001 to 2011, 67 individual organisms were cultured from the respiratory samples of 64 patients. Sixty-five percent of the patients were adults, in whom chronic infections were more common (68%) (P = 0.006). The incidence of B. cepacia complex infection increased by a mean of 12% (95% confidence interval [CI], 3 to 23%) per year. The rates of transplantation and death were similar in the incident cases who developed chronic infection compared to those in patients with chronic Pseudomonas aeruginosa infection. Multilocus sequence typing revealed 50 individual strains from 65 isolates. Overall, 85% of the patients were infected with unique strains, suggesting sporadic acquisition of infection. The yearly incidence of nonepidemic B. cepacia complex infection was positively correlated with the amount of rainfall in the two sites examined: subtropical Brisbane (r = 0.65, P = 0.031) and tropical Townsville (r = 0.82, P = 0.002). This study demonstrates that despite strict cohort segregation, new cases of unrelated B. cepacia complex infection continue to occur. These data also support an environmental origin of infection and suggest that climate conditions may be associated with the acquisition of B. cepacia complex infections.
Formatted abstract
Background: Stenotrophomonas maltophilia is one of the most common multi-drug resistant organisms causing pulmonary infections in CF patients. It is unknown whether S. maltophilia infection follows the same pattern and shares similar risk factors for acquisition as described for Pseudomonas aeruginosa.

Methods: We examined all clinical events from 1997 to 2008 in the Toronto CF Database to identify risk factors for the acquisition of S. maltophilia and to define distinct patterns of infection.

We followed 601 patients over 12years, during which time one quarter of subjects had at least one positive culture for S. maltophilia; the incidence rate was slightly higher in children (11.6/100personyears) compared with adults (10.6/100personyears). Using multi-variable Cox proportional hazards models, steeper rate of FEV1 decline was a significant risk factor for S. maltophilia acquisition, whereas new infections were less likely to occur with greater oral antibiotic use and a history of Burkholderia cepacia complex infection.

This study illustrates the evolution of S. maltophilia infection over time in a large cohort of adults and children with CF. Younger CF patients, and those with greater lung function decline were at increased risk of S. maltophilia infection. The use of oral antibiotics to maintain lung function may be a way of decreasing the risk of infection. However, the optimal management of CF patients with persistent S. maltophilia infection is not yet known and requires further studies.
Keyword Lung Transplantation
Pseudomonas Cepacia
New Zealand
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

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