Burkholderia Cepacia Exit-Site Infection in Peritoneal Dialysis Patients—Clinical Characteristics and Treatment Outcomes. Issue 4 (July 2016)

• Record Type: Journal Article
• Authors: Yap, Desmond Y.H.; Chan, Jasper F.W.; Yip, Terence; Mok, Maggie M.Y.; Kwan, Lorraine P.Y.; Lo, Wai Kei; Chan, Tak Mao
• Is Part Of: Peritoneal dialysis international. Volume 36:Issue 4(2016)
• Page Start: 390
• Page End: 394
• Publication Date: 2016-07
• Subjects: Burkholderia cepacia -- exit-site infection -- peritoneal dialysis; Peritoneal dialysis -- Periodicals; Continuous ambulatory peritoneal dialysis -- Periodicals; 617.461059
• DOI: 10.3747/pdi.2015.00122
• Languages: English
• ISSNs: 0896-8608

Abstract

Background: Burkholderia cepacia is a hardy bacterium with intrinsic resistance to multiple antibiotics and high transmissibility. Opportunistic healthcare-associated B. cepacia infections among immunocompromised or critically ill patients have been reported, but there is limited data on the clinical characteristics and treatment outcomes of exit-site infection (ESI) in peritoneal dialysis (PD) patients. Patients and methods: Patients who suffered from B. cepacia ESI from 1 January 2004 to 31 December 2014 were reviewed. The clinical characteristics and treatment outcomes of the patients and the antibiotic susceptibility patterns of the bacterial isolates were analyzed. Results: Twenty-two patients were included for analysis. Eight patients (36.4%) had medical conditions which impaired host immunity, while 7 (31.8%) had pre-existing skin abnormalities. Three patients (13.6%) progressed to tunnel-tract infection and another 3 patients (13.6%) developed associated peritonitis. Fifteen patients (68.2%) responded to medical treatment while 7 (31.8%) required catheter removal. Eleven patients (50.0%) had recurrent B. cepacia ESI, which occurred at 7.8 months (95% confidence interval [CI] 0.1 – 19.4 months) after the first episode. Most B. cepacia strains were susceptible to ceftazidime (95.5%), piperacillin/tazobactam (95.5%), and piperacillin (90.9%). Besides aminoglycosides (80 – 100%), high rates of resistance were also observed for ticarcillin/clavulanate (90.9%). Conclusion: Burkholderia cepacia ESI is associated with low rates of tunnel-tract infection or peritonitis, but the risk of recurrence is high. Most cases can be managed with medical treatment alone, although one third of patients might require catheter removal.