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A3603 - A Rare Case of Community Acquired Multi-Drug Resistant Burkholderia Cepacia Infection in an Immune Competent Patient
Author Block: K. Gopalratnam1, B. Alkinj1, Z. Saul2, J. Ayala1; 1Dept of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Health- Bridgeport Hospital, Bridgeport, CT, United States, 2Dept of Infectious Diseases, Yale New Haven Health- Bridgeport Hospital, Bridgeport, CT, United States.
INTRODUCTION: Burkholderia Cepacia complex(BCC) are gram negative, catalase producing, non-lactose fermenting bacteria. Here we present a rare case of multi-drug resistant(MDR) community acquired burkholderia pneumonia which was successfully treated with cefepime despite intermediate sensitivity to the medication.
THE CASE: 82 year-old woman with a history of obstructive sleep apnea on continuous positive airway pressure(CPAP) was admitted to the hospital with worsening yellowish-green productive cough, low grade fevers and chills lasting over 2 months. She had been treated with azithromycin and then doxycycline without any improvement. She noted worsening cough and sputum production with CPAP use and had stopped using it over the past 2weeks. Of note, she had not changed the tubing on the machine in over 8months. On exam, she had scattered expiratory wheeze over all lung fields and was hypoxic requiring oxygen supplementation of 3L/min. Computed tomography (CT) scan revealed multiple finger in glove opacities in the left upper lobe, lingula and right lower lobes and tree in bud opacities. She underwent bronchoscopy, lavage and washing in the affected areas which revealed MDR BCC. This was sensitive to trimethoprim-sulfamethoxazole(TMP/SMX) however, the patient had a history of laryngeal edema with its use in the past. She was started on cefepime with intermediate sensitivity and her symptoms began to improve. After a 4week course of treatment, she showed both radiographic and resolution of hypoxia.
DISCUSSION: BCC infection is well described in immunocompromised patients, patients with underlying structural lung abnormalities like cystic fibrosis(CF) or bronchiectasis. Here we describe a case of BCC infection in a non-CF, immune competent patient. Literature review revealed non-CF BCC infection is most often nosocomial and very rare. Transmission via contaminated water, mechanical ventilation, nebulizers have been described in 2 case reports. Patients who develop BCC bacteremia have a very high mortality rate especially in the non-CF population. Early detection and timely intervention with antibiotics is key in management of this infection. MDR BCC infection is also very rare however, this could be attributed to increased use of antibiotics in the community setting. Our patient developed community acquired MDR BCC suspected to be secondary to contaminated CPAP equipment. Due to her severe anaphylactic reaction to TMP/SMX, she was treated with cefepime despite having intermediate sensitivity. Although not ideal, she responded appropriately with resolution of symptoms and radiographic improvement. To our knowledge, this is the first reported case of community acquired MDR BCC pneumonia treated successfully.