Burkholderia cepacia Agent Information Sheet

Boston University
Research Occupational Health Program (ROHP)
617-358-7647

Agent

Burkholderia cepacia are aerobic rod-shaped, free-living, motile Gram- negative bacteria ranging from 1.6- 3.2 μm. They have been found to possess multitrichous polar flagella as well as pili used for attachment. Burkholderia cepacia can be found in soil, water, and infected plants, animals, and humans. B. cepacia has been divided into nine genomic species representing the Burkholderia cepacia complex (BCC). There are at least 17 distinct species. The most common species includes: B. cepacia, B. multivorans III IIIa and B. cenocepacia.

Disease/Infection

Asymptomatic colonizer, cepacia syndrome (rapidly progressive necrotizing pneumonia)

Pathogenicity

Burkholderia cepacia bacteria are often resistant to common antibiotics. Burkholderia cepacia poses little medical risk to healthy people; however, it is a known cause of infections in hospitalized patients. People with certain health conditions, such as sickle cell disease, oncology and burn patients, individuals with chronic lung diseases (particularly cystic fibrosis), that have weakened immune systems may be more susceptible to infections with Burkholderia cepacia. It is also known to cause catheter related infections in hemodialysis patents, skin and soft issue infections, surgical wound infections, and genitourinary tract infections.

Biosafety Information

Risk Group/BSL
Risk Group 2
Biosafety Level 2

Modes of Transmission.
Person to person or contaminated surfaces to person. Outbreaks reported from contaminated mouthwash, nasal spray, and sublingual probes.

Transmission
Skin Exposure (Needlestick, bite, or scratch):Yes
Mucous Membrane Splash to Eye(s), Nose or Mouth:Yes
Inhalation:No
Ingestion:Yes

Host Range/Reservoir
Host Range – Human
Reservoir – Environmental soil and water

Symptoms
Wide range from asymptomatic to serious fatal respiratory illness especially in cystic fibrosis patients.

Incubation period
Is a colonizer, disease may not manifest until infection is caused during an opportunistic setting.

Viability
Can survive contact with betadine and benzalkonium chloride. 10% bleach (sodium hypochlorite).

Survival Outside Host
Does not appear to survive on dry surfaces for more than 1 week, but can survive for many months in water.

Information for Lab Workers

Laboratory PPE

Laboratory coat, gloves, eye protection but not limited to must be worn when in contact with infectious materials,

Containment

Biosafety level 2 practices, containment equipment and facilities for activities involving cultures and infected clinical materials

In Case of Exposure/Disease

  • For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
    • Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
    • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
      You will be referred to or transported to the appropriate health care location by the emergency response team.
  • For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
  • Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
  • Provide the wallet-size agent ID card to the physician.

Vaccination

No vaccine available for Burkholderia cepacia

Information for First Responders/Medical Personnel

Public Health Issues

Standard precautions should be used. As discussed above, in immune competent patients, transmission does not carry risk of infection.

Diagnosis/ Surveillance

Bacteriological identification of infection through clinical cultures

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

Skin Exposure (Needlestick or scratch):Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution.
Mucous Membrane Splash to Eye(s), Nose or Mouth:Exposure should be irrigated vigorously.
Splash Affecting Garments:Remove garments that may have become soiled or contaminated and place them in a double red plastic bag.

Treatment Options

Treatment of symptomatic infections is based on antibiotic resistance pattern.

Primary regimen:

  • TMP-SMX 8 – 10mg/kg/day IV divided Q6hrs or Q8h
  • Meropenem 0.5 – 1gm IV Q8h
  • Ciprofloxacin 400mg IV Q12h

Alternative Regimen

  • Minocycline 200mg IV load, then 100mg IV/PO BID
  • Chloramphenicol 50 – 100mg/kg/day IV/PO divided Q6h, max daily dose 4

References

Willey, Microbiology 7th edition, McGraw Hill, 2008.

Mandell, Douglas, and Bennett’s Principles and practices of Infectious Disease 6th Edition, Elsevier, 2005.

CDC – Healthcare associated infections – http://www.cdc.gov/HAI/organisms/organisms.html

Holmes A. et al, Agricultural use of Burkholderia (Pseudomonas) cepacia: a threat to human health? Emerg Infect Dis. 1998 Apr-Jun; 4(2): 221–227. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640135/

Adam Baldwin, Eshwar Mahenthiralingam et al. http://www.cdc.gov/eid/content/13/3/458.htm. Environmental Burkholderia cepacia Complex Isolates from Human Infections. Emerg Infect Dis. Volume 13, Number 3—March 2007

Revised: 6/11/2014

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