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Não fermentadores

Burkholderia cepacia complex

Gram-negative bacilli

Identification & Growth

Identification

  • Weakly oxidase-positive, lysine-positive, non-fermenter
  • Selective BCSA/OFPBL agar

Growth Conditions

  • Slow growth: 48–72 h at 35 °C; colonies may show a yellowish pigment

Clinical Significance

  • Pulmonary infection in cystic fibrosis, outbreaks from contaminated solutions

Intrinsic Resistance

  • Colistin/polymyxin B, aminoglycosides, ampicillin and first-/second-generation cephalosporins (EUCAST Expected Resistant Phenotypes v1.2)
  • Ertapenem

Bench Alerts

  • Naturally polymyxin-resistant — a useful identification clue
  • Isolation from serum/solutions suggests product contamination: investigate immediately
  • Options: SXT, meropenem, ceftazidime, minocycline

Clinical Notes

Clinical presentations

  • Causes severe chronic pulmonary infection in cystic fibrosis patients, potentially progressing to cepacia syndrome with rapid deterioration and sepsis.
  • Is a cause of healthcare-associated infections due to contamination of aqueous solutions, including bloodstream infection originating from intravenous fluids.
  • Can cause pneumonia in patients with chronic granulomatous disease.

Specimens and collection

  • Sputum from cystic fibrosis patients should be cultured on complex-selective media due to slow growth and overgrowth by other organisms.
  • Blood cultures should investigate a common source during outbreaks, including contaminated parenteral solutions and antiseptics.
  • Species-level identification within the complex is epidemiologically relevant and should be referred to a reference laboratory.

Epidemiology and at-risk populations

  • Cystic fibrosis patients are at risk of person-to-person transmission, prompting segregation in specialized treatment centers.
  • Is an environmental contaminant of water and aqueous solutions, causing hospital outbreaks associated with pharmaceutical products and antiseptics.
  • Patients with chronic granulomatous disease have increased susceptibility to invasive infection.

Resistance and therapeutic implications

  • Exhibits intrinsic resistance to polymyxins and aminoglycosides, limiting usual empiric gram-negative therapeutic options.
  • Trimethoprim-sulfamethoxazole, meropenem, and ceftazidime are frequently used therapeutic options, guided by individual susceptibility testing.
  • Resistance profiles vary widely among complex species, requiring individualized susceptibility testing.

Bench and reporting notes

  • Slow-growing, non-fermenting gram-negative bacillus with variable oxidase reaction, requiring selective media for recovery from respiratory specimens.
  • Correct identification is critical for cohorting decisions and infection control in cystic fibrosis centers.
  • Mass spectrometry (MALDI-TOF) may have limitations differentiating species within the complex, potentially requiring genetic sequencing.

Sources

Educational decision-support content. It does not replace laboratory validation, current guidelines or review by the responsible professional.

FAQ: Frequently Asked Questions

How to identify Burkholderia cepacia complex in the lab?

Burkholderia cepacia complex is identified through weakly oxidase-positive, lysine-positive, non-fermenter, selective bcsa/ofpbl agar.

What are the intrinsic resistances of Burkholderia cepacia complex?

This organism is naturally resistant to colistin/polymyxin b, aminoglycosides, ampicillin and first-/second-generation cephalosporins (eucast expected resistant phenotypes v1.2), ertapenem. These drugs should not be reported as susceptible.

Where is Burkholderia cepacia complex commonly found?

It is typically associated with pulmonary infection in cystic fibrosis, outbreaks from contaminated solutions.

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