There is a paucity of information available about the prevalence and clinical relevance of disease related to Burkholderia gladioli, a gram-negative organism identified in at risk patient populations including patients with cystic fibrosis (CF) and other chronic airway diseases and immunosuppressed patients.
A retrospective review was performed using patient medical records for all patients who had one or more positive B. gladioli cultures from any organ, at UNC hospital between September 1999 and September 2004. Medical records of all cases were reviewed and data recorded about age, sex, ethnicity, comorbidities, pulmonary function tests, frequency of positive cultures, length of follow-up, sensitivity testing, other organisms cultured, and evidence of complications including mortality and inpatient therapy. FEV1 in CF patients age 10-30 was compared to the national median FEV1 for age.
A total of 26 patients had cultures (all respiratory) that grew B. gladioli including 24 CF patients (sputum positive prevalence of 3.6%), one patient with primary ciliary dyskinesia and one trauma patient on mechanical ventilation. Lung disease in CF patients was variable as reflected by FEV1 in comparison to the national median FEV1 for age. Repeat sputum cultures were available in 19/21 CF patients who were not transplanted of which 6 were continuously culture positive (32%) and 13 (68%) cultured positive on one (n=9) or more occasion with subsequent negative cultures. 22/24 CF patients had mycobacterial cultures (n=15≥2 cultures) and all were negative (expected prevalence=15-20% [Oliver et al AJRCCM 167, 2003]). Three CF patients cultured positive for B. gladioli pre and post bilateral lung transplantation, two with no complication and one complicated by a mediastinal abscess secondary to B. gladioli treated successfully with combined medical and surgical intervention. 48% of isolates were generally susceptible to TMP/SMX, ciprofloxacin, aminoglycosides, carbapenem, anti-pseudomonal penicillens and cephalosporins.
The majority of patients’ culture positive for B. gladioli at our center have CF with variable severity of pulmonary disease.
B. gladioli infection does not appear to contraindicate lung transplantation.
Marcus Kennedy, None.