Comparative suseptibility testing in burkholderia species
Pitman, Katherine Jayne
Cardiff Metropolitan University
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Cystic Fibrosis (CF) has been recognised as the most common life shortening childhood onset inherited disease, affecting over 8000 children and young adults in the UK. Burkholderia cepacia complex (Bcc) is a diverse group of human pathogens that is capable of causing life threatening lung infections in patients with CF. Currently the Bcc consists of nine genomovars, B. cepacia (I), B. multivorans (II), B. cenocepacia (III), B. stabilis (IV), B. vietnamiensis (V), B. dolosa (VI), B. ambifaria (VII), B. anthina (VIII), and B. pyrrocinia (IX). Bcc infections are often difficult to treat due to intrinsic resistance to many antibiotics commonly used in CF treatment, such as aminoglycosides and β-lactams. At present there are limited guidelines and minimal data available from EUCAST or BSAC for antimicrobial susceptibility of Bcc. Automated identification systems are becoming increasingly used in diagnostic laboratories as a sole means to identify bacteria. This study aims to evaluate the BD Phoenix™ automated microbiology system for identification and differentiation of Burkholderia spp, and to determine the potential temperature and methodology (BSAC and EUCAST) variability in antimicrobial susceptibilities of Bcc isolates representing all genomovars to establish the optimal method for predictive susceptibility testing of Bcc. The BD Phoenix™ automated system does not misidentify Burkholderia spp. at genus level. However it may fail to give an identification, alternative methods are required to establish the important species-level identification. Although intrinsic resistance is considered to be a common feature of the Bcc, MICs of individual antimicrobials varied widely and resistance was not exhibited by all members of the group. Method, genomovar status and temperature variability in sensitivity can occur in Bcc, which can lead to categorical changes in susceptibility. The majority of Bcc isolates were sensitive to ceftazidime, meropenem, co-trimoxazole and pip/tazobactam and resistant to amikacin and ciprofloxacin by both methodologies and temperature respectively. The ISO disc diffusion method and interpretive criteria by EUCAST described herein provide a convenient method that can be used for epidemiological surveys of Bcc resistance or clinical analysis in which medical staff need confirmation that the antibiotics being used for empirical therapy of Bcc infections in CF patients will likely to be effective, or in resource-limited settings in which MIC determination methods are not readily available.
MSc Biomedical Science
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