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Burkholderia cepacia

Burkholderia cepacia. Helgi Karl Engilbertsson 25. febrúar 2004. Burkholderia cepacia sýkingar. Sepsis Pneumonia Meningitis Cellulitis Peritonitis Endocarditis Pericarditis Cholangitis Septic arthritis Urinary tract infections. Medically Important Pseudomonads.

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Burkholderia cepacia

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  1. Burkholderia cepacia Helgi Karl Engilbertsson 25. febrúar 2004

  2. Burkholderia cepacia sýkingar • Sepsis • Pneumonia • Meningitis • Cellulitis • Peritonitis • Endocarditis • Pericarditis • Cholangitis • Septic arthritis • Urinary tract infections

  3. Medically Important Pseudomonads • rRNA homology group I-V • Gr. I Pseudomonas, 6 teg • Gr. IIa Burkholderia, a.m.k. 22 teg • Gr. IIb Ralstonia, 4 teg • Gr. IIc Oxalobacter, 1 teg • Gr. IId Pandorae, 4 teg • Gr. III Comamonas, 2 teg • Gr. IV Brevundimonas, 2 teg • Gr. V Stenotrophomonas, 2 teg

  4. Microbiology • Gram-negatífur stafur • Extracelluler • Aerobic • Non-fermentive • Catalase • Flagella • 2-4 circular replicons í stað circular chromosomes • Erfitt að einangra • Ræktun í sérhæfðu media

  5. Burkholderia cepacia

  6. Burkholderia cepacia • Pseudomonas cepacia var lýst fyrst árið 1950 af WalterBurkholder (Cornell University plant pathologist ), þá sem plöntupathogen. Veldur rotnun í lauk (latína, cepia) • Siðar kemur í ljós að tækfæris human pathogenarnir P. Kingii og P. Multivarans voru sömu tegundar. • Síðustu 10 ár komið í ljós við taxonímískar rannsóknir stofn baktería, Burkholder cepacia complex

  7. Burkholder cepacia complex • Mismunandi genotypur með mjög svipaðar phenotypur • Genomovar I-IX • B. cepacia • B. multivorans • B. cenocepacia • B. Stabilis • B. Vietnamiensis • B. Dolosa • B. Ambifaria • B. Anthina • B. pyrrocinia

  8. Burkholder cepacia • Finnst víða: • Vatni • Jarðvegi • Dýrum • Mönnum • Spítalaumhverfi • Kranavatn • Innúðavélar • Dialysuvélar • Sótthreinsivökva • IV lausnir • Catheterar • Og fleira

  9. Burkholderia cepacia sýkingar • Tækifærissýkill • Algengast hjá sjúklingum með undirliggjandi sjúkdóma • Cystic fibrosis • 3,5 % CF sjúklinga í USA • 20-30% sýkinga enda með bacteremiu og dauða • Chronic granulomatous disease • Ónæmisbældum • DM • Malignancy • Hjartabilun • COPD

  10. Burkholderia cepacia pathogenesis • Virulence faktorar • Lyfjaónæmi • Adherance við plast • Exoenzyme • Elastasi • Gelatinasi • Adhesin • Resistance to nonoxative killing of neutrophils • Intracellular survival • Siderophores • Hemolysin • Exopolysaccharide • Pili • Flagella

  11. Burkholderia cepacia pathogenesis • Finnast helst í öndunarvegi • Colonisering frekar en sýking yfirleitt • Sýking getur leitt til • Necrotizing pneumonia • Bacteremiu • Ecthyma gangrenosum • DIC • Septísks shock • Multible organ dysfunction syndrome

  12. Ecthyma gangrenosum

  13. Burkholderia cepacia lyfjaónæmi • Beta-laktamasi • Penicillín resistance • Dihydrofolate reductasi • Trimethoprim resistance • Antibiotic efflux pump • Chloramphenicol, quinolone og trimethoprim resistance • Ytri himnu ógegndræpi • Quinolone resistance • Breyting á bindistað lyfja

  14. Burkholderia cepacia meðferðCystic Fibrosis • Minocycline 33% næmi • Meropenem 28% • Chloramphenicol/Minocycline 49% • Chloramphenicol/Ceftazidime 26%

  15. Burkholderia cepacia meðferðBacteremia • Ceftazidime (95%) • Piperacillin (93%) • Minocycline (85%) • Cefotaxime (82%) • Ciprofloxacin • Imipenem • Meropenem • Quinolones • Trimethoprim • Chloramphenicol

  16. MIC = Minimum inhibitory concentration MIC breakpoints for resistance: Piperacillin ≥128 μg/ml, Ceftazidime ≥32 μg/ml, imipenem ≥16 μg/ml, gentamicin ≥16 μg/ml, minocycline ≥16 μg/ml, Ciprofloxacin ≥4 μg/ml

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