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Abstract：
Burkholderia cepacia complex (Bcc) are a group of multidrug-resistant gram-negative bacteria rarely reported in patients without cystic fibrosis (CF) or immunocompromising conditions. We investigated Bcc bloodstream infections (BSIs) in a cohort of non-CF patients from the US Veterans Health Administration (VHA).
Using VHA databases, we identified patients with Bcc BSI at facilities nationwide from 1999 through 2015. We ascertained clinical characteristics, treatments, and outcomes and identified factors associated with 30-day mortality in logistic regression analysis.
We identified 248 patients with Bcc BSI, who were of advanced age (mean, 68 years), chronically ill, and had severe disease. The most common sources were central venous catheters (41%) and pneumonia (20%). Most cases were hospital-acquired (155 [62%]) or healthcare-associated (70 [28%]). Mortality at 14, 30, and 90 days was 16%, 25%, and 36%, respectively. Trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolones were active against 94% and 88% of isolates, respectively. Susceptibility to ceftazidime and meropenem occurred in approximately 70% of the isolates. The most prescribed antibiotics were fluoroquinolones (35%), followed by carbapenems (20%), TMP-SMX (18.5%), and ceftazidime (11%). In regression analysis, age (OR, 1.06 [95% confidence interval {CI}, 1.02-1.10], per added year) and the Pitt bacteremia score (OR, 1.65 [95% CI, 1.44-1.94], per unit increase) were associated with higher 30-day mortality.
In this large cohort of BSIs caused by Bcc, cases were mostly hospital-acquired and we observed high mortality, significant resistance to ceftazidime, and limited use of TMP-SMX. These observations add to our understanding of Bcc infection in non-CF patients and highlight the need for interventions to improve their outcome.
Using VHA databases, we identified patients with Bcc BSI at facilities nationwide from 1999 through 2015. We ascertained clinical characteristics, treatments, and outcomes and identified factors associated with 30-day mortality in logistic regression analysis.
We identified 248 patients with Bcc BSI, who were of advanced age (mean, 68 years), chronically ill, and had severe disease. The most common sources were central venous catheters (41%) and pneumonia (20%). Most cases were hospital-acquired (155 [62%]) or healthcare-associated (70 [28%]). Mortality at 14, 30, and 90 days was 16%, 25%, and 36%, respectively. Trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolones were active against 94% and 88% of isolates, respectively. Susceptibility to ceftazidime and meropenem occurred in approximately 70% of the isolates. The most prescribed antibiotics were fluoroquinolones (35%), followed by carbapenems (20%), TMP-SMX (18.5%), and ceftazidime (11%). In regression analysis, age (OR, 1.06 [95% confidence interval {CI}, 1.02-1.10], per added year) and the Pitt bacteremia score (OR, 1.65 [95% CI, 1.44-1.94], per unit increase) were associated with higher 30-day mortality.
In this large cohort of BSIs caused by Bcc, cases were mostly hospital-acquired and we observed high mortality, significant resistance to ceftazidime, and limited use of TMP-SMX. These observations add to our understanding of Bcc infection in non-CF patients and highlight the need for interventions to improve their outcome.
摘要：
洋葱伯克霍尔德氏菌（Bcc）是一组耐多药的革兰氏阴性菌，在没有囊性纤维化（CF）或免疫功能低下的患者中很少报道。我们调查了来自美国退伍军人健康管理局（VHA）的非CF患者队列中的Bcc血流感染（BSI）。
使用VHA数据库，我们确定了1999年至2015年在全国范围内的BccBSI患者.我们确定了临床特征，治疗,和结果，并在逻辑回归分析中确定与30天死亡率相关的因素。
我们确定了248例BccBSI患者，高龄的人(意思是，68年),长期患病,患有严重疾病。最常见的来源是中心静脉导管（41％）和肺炎（20％）。大多数病例是医院获得性(155[62%])或医疗保健相关(70[28%])。14、30和90天的死亡率为16%，25%,36%,分别。甲氧苄啶-磺胺甲恶唑（TMP-SMX）和氟喹诺酮类药物对94％和88％的分离株具有活性，分别。对头孢他啶和美罗培南的易感性发生在大约70%的分离株中。处方最多的抗生素是氟喹诺酮类（35%），其次是碳青霉烯类(20%)，TMP-SMX（18.5%），和头孢他啶(11%)。在回归分析中，年龄（或，1.06[95%置信区间{CI}，1.02-1.10],每增加一年)和皮特菌血症评分(OR，1.65[95%CI，1.44-1.94]，每单位增加)与更高的30天死亡率相关。
在由Bcc引起的大量BSI中，病例大多是医院获得的，我们观察到高死亡率，对头孢他啶有显著的抗性,以及TMP-SMX的有限使用。这些观察结果增加了我们对非CF患者Bcc感染的理解，并强调了需要干预措施来改善其结果。
使用VHA数据库，我们确定了1999年至2015年在全国范围内的BccBSI患者.我们确定了临床特征，治疗,和结果，并在逻辑回归分析中确定与30天死亡率相关的因素。
我们确定了248例BccBSI患者，高龄的人(意思是，68年),长期患病,患有严重疾病。最常见的来源是中心静脉导管（41％）和肺炎（20％）。大多数病例是医院获得性(155[62%])或医疗保健相关(70[28%])。14、30和90天的死亡率为16%，25%,36%,分别。甲氧苄啶-磺胺甲恶唑（TMP-SMX）和氟喹诺酮类药物对94％和88％的分离株具有活性，分别。对头孢他啶和美罗培南的易感性发生在大约70%的分离株中。处方最多的抗生素是氟喹诺酮类（35%），其次是碳青霉烯类(20%)，TMP-SMX（18.5%），和头孢他啶(11%)。在回归分析中，年龄（或，1.06[95%置信区间{CI}，1.02-1.10],每增加一年)和皮特菌血症评分(OR，1.65[95%CI，1.44-1.94]，每单位增加)与更高的30天死亡率相关。
在由Bcc引起的大量BSI中，病例大多是医院获得的，我们观察到高死亡率，对头孢他啶有显著的抗性,以及TMP-SMX的有限使用。这些观察结果增加了我们对非CF患者Bcc感染的理解，并强调了需要干预措施来改善其结果。
