Rapid emergence of a ceftazidime-resistant Burkholderia multivorans strain in a cystic fibrosis patient.

TitleRapid emergence of a ceftazidime-resistant Burkholderia multivorans strain in a cystic fibrosis patient.
Publication TypeJournal Article
Year of Publication2013
AuthorsStokell JR, Gharaibeh RZ, Steck TR
JournalJ Cyst Fibros
Volume12
Issue6
Pagination812-6
Date Published2013 Dec
ISSN1873-5010
KeywordsAdult, Anti-Bacterial Agents, Burkholderia, Ceftazidime, Colony Count, Microbial, Cystic Fibrosis, Disease Progression, Drug Resistance, Bacterial, Humans, Male, Multilocus Sequence Typing, Sputum, Time Factors
Abstract

<p><b>BACKGROUND: </b>Burkholderia multivorans poses a serious health threat to cystic fibrosis patients due to innate resistance to multiple antibiotics and acquisition of resistance to a range of antibiotics due to the frequent use of antibiotics to treat chronic infections. Monitoring antibiotic susceptibility is crucial to managing patient care. We identified the rapid emergence of a ceftazidime-resistant strain in a single patient within four days during a hospitalization for treatment of an exacerbation.</p><p><b>METHODS: </b>B. multivorans was isolated from expectorated sputum samples using Burkholderia cepacia selective agar. A macrodilution assay was performed on all isolates to determine the minimum inhibitory concentration of ceftazidime. Approximately 4000 colonies were scored to identify the percent of ceftazidime-resistant colonies. Extracted DNA was used to determine the total bacterial counts and abundance of B. multivorans using quantitative PCR.</p><p><b>RESULTS: </b>An increase from no detectable B. multivorans ceftazidime-resistant colonies to over 75% of all colonies tested occurred within a four-day period. The resistant population remained dominant in 6 of the 8 samples in the following 17 months of the study. qPCR revealed an association between change in the percent of resistant colonies and abundance of B. multivorans, but not of total bacteria. No association was found between the acquisition of resistance to ceftazidime and other antibiotics commonly used to treat B. multivorans infections.</p><p><b>CONCLUSIONS: </b>The rapid emergence of a ceftazidime-resistant by B. multivorans strain occurred during a hospitalization while under selective pressure of antibiotics. The resistant strain maintained dominance in the B. multivorans population which resulted in an overall decline in a patient health and treatment efficacy.</p>

DOI10.1016/j.jcf.2013.01.009
Alternate JournalJ. Cyst. Fibros.
PubMed ID23478130