Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit
Journal
Diagnostic Microbiology and Infectious Disease
Journal Volume
70
Journal Issue
2
Pages
260-266
Date Issued
2011
Author(s)
Abstract
The purpose of this study was to investigate a cohort of patients with Burkholderia cepacia bacteremia in the intensive care unit (ICU) at our institution. A large outbreak of B. cepacia bacteremia involving 95 patients lasted for 4 years in an ICU in northern Taiwan. The clinical characteristics and antimicrobial treatment responses of these patients were analyzed. Minimal inhibitory concentrations were determined and pulse-field gel electrophoresis was performed for the 73 available isolates. Overall, the in-hospital mortality rate was 53.8% and the 14-day mortality rate was 16.8%. Most patients (95.6%) had several underlying diseases and all but 1 patient had tracheal intubation. Malignancy (37.5% versus 13.9%, P = 0.02) and higher Sequential Organ Failure Assessment (SOFA) scores at the onset of bacteremia (11.9 ± 4.7 versus 7.9 ± 3.6, P < 0.001) were significant risk factors for 14-day mortality. In contrast, treatment with ceftazidime (76.0% versus 43.7%, P = 0.02) and diabetes (51.9% versus 13.8%, P = 0.01) were associated with decreased mortality. In the multivariate analysis, malignancy and higher SOFA score were significant risk factors for mortality [odds ratio (OR) 12.45, 95% confidence interval (CI) 2.35-65.94; OR 1.20, 95% CI 1.00-1.45, respectively]. Meropenem, ceftazidime, and piperacillin-tazobactam were the most active agents (susceptible rate 100%, 97.3%, and 97.3%, respectively). Pulsed-field gel electrophoresis results indicated 49 of the 73 isolates could be classified as outbreak-related strains. There was no significant difference in the clinical characteristics and outcomes of patients with bacteremia due to outbreak-related and non-outbreak-related strains. In conclusion, malignancy and a higher SOFA score at onset of bacteremia predicted increased mortality, but the clinical presentation and outcome of patients with outbreak and non-outbreak strains were similar. ? 2011 Elsevier Inc.
SDGs
Other Subjects
ceftazidime; colistin; cotrimoxazole; imipenem; levofloxacin; meropenem; minocycline; moxifloxacin; piperacillin plus tazobactam; tetracycline; tigecycline; aged; antibiotic sensitivity; article; bacteremia; bacterial strain; Burkholderia cepacia; Burkholderia infection; controlled study; diabetes mellitus; endotracheal intubation; epidemic; female; human; intensive care; major clinical study; male; malignant neoplastic disease; minimum inhibitory concentration; mortality; nonhuman; priority journal; prognosis; pulsed field gel electrophoresis; scoring system; Sequential Organ Failure Assessment score; survival rate; Taiwan; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Burkholderia cepacia; Burkholderia Infections; Cohort Studies; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Humans; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Typing; Risk Factors; Taiwan; Treatment Outcome
Type
journal article