Fatal Outcome of Lung Transplantation in Cystic Fibrosis Patients due to Small-Colony Variants of the Burkholderia cepacia Complex

Aim: to evaluate the infection rate and resistance of isolated Achromobacter xylosoxidans to carbapenems in adult cystic fibrosis patients (CF). Patients and Methods: a retrospective analysis of the results of culture test and time-of-flight mass spectrometry MALDI-TOF was conducted: 685 sputum samples of 58 adult CF patients for a period of 5 years (2016–2020). To assess the sensitivity to imipenem and meropenem, the agar gradient diffusion and disk diffusion method were used. Results: the incidence of infection with A. xylosoxidans in adult CF patients for the period from 2016 to 2020 when monitoring a single sample of patients (n=24) to evaluate the occurrence of this pathogen with increasing age ranged from 16.6% in 2016–2017, increasing to 37.5% in 2018–2019, and with a further reduction to 20.8% (associated with disease fatal outcome in 3 of the 9 infected patients). There was no statistically significant dependence of the fatal outcome on infection with A. xylosoxidans. When analyzing the entire pool of patients (n=58) from 2016 to 2020, the release frequency of Pseudomonas aeruginosa remains approximately the same, varying from 63.3% to 46.5% and maintaining a numerical advantage in all follow-up periods, while the A. xylosoxidans infection ranges from 13.7% to 39.3%. In 2016–2018, 50% of isolates were sensitive to carbapenems, in 2018 — 53.8% of isolates, in 2019–2020 — the activity of obtained isolates decreased to 37.5% and 30.7%, respectively. Conclusion: despite the dynamics of indicators and the sample size, the dynamics over 5 years maintained a group-wide proportion of microbiome species dominated primarily by Pseudomonas infection and A. xylosoxidans. In our follow-up, the activity of carbapenems in relation to A. xylosoxidans has almost halved. KEYWORDS: cystic fibrosis, Burkholderia cepacia complex, Achromobacter xylosoxidans, Pseudomonas aeruginosa, lethality, antibiotic resistance, carbapenems. FOR CITATION: Makhmutova V.R., Gembitskaya T.E., Chermensky A.G. et al. Achromobacter xylosoxidans infection and resistance monitoring in adult cystic fibrosis patients. Russian Medical Inquiry. 2021;5(7):462–467 (in Russ.). DOI: 10.32364/2587-6821-2021-5-7-462-467.

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Prevalence and clonality of Burkholderia cepacia complex genomovars in UK patients with cystic fibrosis referred for lung transplantation

Thorax ◽

10.1136/thx.2003.010801 ◽

2004 ◽

Vol 59 (6) ◽

pp. 526-528 ◽

Cited By ~ 31

Author(s):

A De Soyza

Keyword(s):

Cystic Fibrosis ◽

Lung Transplantation ◽

Burkholderia Cepacia ◽

Burkholderia Cepacia Complex

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Burkholderia cepacia complex: a contraindication to lung transplantation in cystic fibrosis?

Transplant Infectious Disease ◽

10.1034/j.1399-3062.2001.003003149.x ◽

2001 ◽

Vol 3 (3) ◽

pp. 149-160 ◽

Cited By ~ 25

Author(s):

J.J. LiPuma

Keyword(s):

Cystic Fibrosis ◽

Lung Transplantation ◽

Burkholderia Cepacia ◽

Burkholderia Cepacia Complex

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Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients

Journal of Clinical Medicine ◽

10.3390/jcm10061275 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1275

Author(s):

Anna Engell Holm ◽

Hans Henrik Lawaetz Schultz ◽

Helle Krogh Johansen ◽

Tania Pressler ◽

Thomas Kromann Lund ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Transplantation ◽

Burkholderia Cepacia ◽

Bacterial Species ◽

Positive Culture ◽

Burkholderia Cepacia Complex ◽

Achromobacter Xylosoxidans ◽

Lung Function Decline ◽

Before And After ◽

The Impact

Most cystic fibrosis (CF) patients referred for lung transplantation are chronically infected with Gram-negative opportunistic pathogens. It is well known that chronic infections in CF patients have a significant impact on lung-function decline and survival before transplantation. The rate and timing of re-colonization after transplantation have been described, but the impact on survival after stratification of bacteria is not well elucidated. We did a single-center retrospective analysis of 99 consecutive CF patients who underwent lung transplantation since the beginning of the Copenhagen Lung Transplant program in 1992 until October 2014. Two patients were excluded due to re-transplantation. From the time of CF diagnosis, patients had monthly sputum cultures. After transplantation, CF-patients had bronchoscopy with bronchoalveolar lavage at 2, 4, 6 and 12 weeks and 6, 12, 18 and 24 months after transplantation, as well as sputum samples if relevant. Selected culture results prior to and after transplantation were stored. We focused on colonization with the most frequent bacteria: Pseudomonas aeruginosa (PA), Stenotrophomonas maltophilia (SM), Achromobacter xylosoxidans (AX) and Burkholderia cepacia complex (BCC). Pulsed-field gel electrophoresis (PFGE) was used to identify clonality of bacterial isolates obtained before and after lung transplantation. Time to re-colonization was defined as the time from transplantation to the first positive culture with the same species. Seventy-three out of 97 (75%) had sufficient culture data for analyses with a median of 7 (1–91) cultures available before and after transplantation. Median colonization-free survival time was 23 days until the first positive culture after transplantation. After 2 years, 59 patients (81%) were re-colonized, 33 (48.5%) with PA, 7 (10.3%) with SM, 12 (17.6%) with AX, and 7 (10.3%) with BCC. No difference in survival was observed between the patients colonized within the first 2 years and those not colonized. Re-colonization of bacteria in the lower airways occurred at a median of 23 days after transplantation in our cohort. In our patient cohort, survival was not influenced by re-colonization or bacterial species.

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