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A3613 - Burkholderia Cepacia Bacteremia in an Immunocompetent Host
Author Block: H. Singh1, J. Safi1, J. R. Tedrow2; 1Pulmonary and Critical Care Medicine, St. Elizabeth Medical Center, Brighton, MA, United States, 2Pulmonary/Critical Care, St. Elizabeth's Medical Center, Brighton, MA, United States.
Background: Burkholderia cepacia complex is a group of Gram-negative non-lactose fermenting bacteria rarely reported in patients without immunocompromise. B cepacia complex was believed to be only a plant pathogen but it has emerged as an important opportunistic pathogen causing morbidity and mortality in hospitalized patients. B cepacia is commonly found in natural environments such as soil, water, rhizosphere and agriculture products. Patients with cystic fibrosis or chronic granulomatous disease are predisposed to B cepacia complex infections. B cepacia can survive for a long period of time and can easily multiply in aqueous environments such as disinfectant agents and intravenous fluids used in hospitals. Case description: In this case, we describe a 59-year old male with history of hypertension, gout, anxiety, depression, alcohol abuse with delirium tremens. He was admitted for change in mental status after unwitnessed fall. He developed acute multiorgan failure with rhabdomyolysis, shock and evidence of right lower lobe infiltrates on initial chest x-ray. His admission labs exhibited leukocytosis, severe lactic acidosis, mild transaminitis, and elevated CPK. He had acute renal failure initially requiring CVVH, but eventually had renal recovery. Sputum samples from admission grew Burkholderia species, with a typical resistant pattern, sensitive to meropenem and sulfamethoxazole/trimethoprim. This was not initially treated because of the improvement of his clinical gestalt with empiric therapy. Then, 11 days later, he had a setback due to respiratory failure requiring mechanical ventilation. He grew Burkholderia cepacia group in blood as well as tracheal aspirate. This was treated with meropenem. The patient responded well and was extubated and eventually discharged from the hospital. There is no evidence of cystic fibrosis or any other chronic lung disease in our patient. He has no known exposures to any source of B cepacia. Conclusion/Discussion: Finally, we report a case of bacteremia due to B cepacia in an immunocompetent host who has no underlying lung disease. He recovered well once this disease process was recognized as a pathogen in our patient and appropriately treated. Through our case we highlight the fact that we do not have much guidance on how to approach this group of bacteria when it’s encountered in an otherwise immunocompetent patient. The best advice is to decide on individual cases if to treat or not.