Burkholderia species

Burkholderia species

Background:
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Non-fermenting Gram-negative bacilli   
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[cannot catabolize glucose and therefore are not able to ferment. Non-spore forming.]
>Acinetobacter baumannii
>Achromobacter xylosoxidans
>Bordetella pertussis
>Burkholderia species:  Led
     1] Burkholderia cepacia (also known as Pseudomonas cepacia) –  important
            pathogen of pulmonary infections in people with cystic fibrosis.
     2] Burkholderia pseudomallei (also known as Pseudomonas pseudomallei) 
>Elizabethkingia meningoseptica (Previously Chryseobacterium meningosepticum)
>Moraxella catarrhalis (formerly known as Branhamella catarrhalis)
>Pseudomonas aeruginosa
>Stenotrophomonas maltophilia (Initially classified as Pseudomonas maltophilia)

Burkholderia: 

  • Burkholderia (previously part of Pseudomonas) genus name refers to a group of virtually ubiquitous gram-negative, motile, obligately aerobic rod-shaped bacteria including both animal/human.  Genus of proteobacteria.
  • Pathogenic members include:
    • Burkholderia mallei: responsible for glanders disease (mostly in animals)
    • Burkholderia pseudomallei: causative agent of melioidosis; and
    • Burkholderia cepacia: an important pathogen of pulmonary infections in people with cystic fibrosis (CF).
  • Due to their antibiotic resistance and the high mortality rate from their associated diseases Burkholderia mallei and Burkholderia pseudomallei are considered to be potential biological warfare agents, targeting livestock and humans.

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Therapy:
Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first.   Listed dosages may need to be adjusted for renal dysfunction.  

 Burkholderia cepacia:

  1. Bactrim Mild-moderate infection:  8 to 10 mg/kg/day (based on trimethoprim component)  IV divided in 2-4 doses.    Severe infection: 15 to 20 mg/kg/day (based on trimethoprim component)  IV, given in equally divided doses every 6 to 8 hours.
  2. Ciprofloxacin  400mg IV q12h (Severe/complicated: 400mg IV q8h)
  3. Third-generation cephalosporins potentially effective.
  4. Meropenem 0.5 – 1 gram IV q8h
  5. Minocycline: Usual dosage (IV): 200 mg x 1,  followed by 100mg q12h.
  6. Chloramphenicol 50-100 mg/kg/day in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)

Burkholderia pseudomallei:

  1. Ceftazidime 2 grams IV q8h
  2. Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h]
  3. Meropenem 0.5 – 1 gram IV q8h  (life-threatening infection -unlabeled use: 2 grams IV q8h)
  4. Combination therapy:
    Doxycycline 100mg oral /IV twice daily [Range: 100-200mg in 1-2 divided doses  PLUS 
    Bactrim  5 to 10 mg/kg/day (based on trimethoprim component)  IV/oral divided in 2-4 doses 
    +/-
    Chloramphenicol 50-100 mg/kg/day IV in divided doses every 6 hours (Maximum daily dose is 4 grams e.g. 1 gram q6h)
Burkholderia species