Guillain-Barre sendromu nedeniyle hastanede yatan bir hastada gelişen Burkholderia cepacia sepsisi

Year 2011, Volume: 68 Issue: 4, 197 - 202, 01.12.2011

Orhan Baylan Mehmet Burak Selek Semih Alay Oral Öncül Mustafa Özyurt Tunçer Haznedaroğlu

Abstract

Burkholderia cepacia, yoğun bakım ünitelerinde takip edilen, özellikle kistik fibrozisli veya bağışıklık sistemi baskılanmış hastalarda nekrotizan pnömoni, sepsis/bakteriyemi ve salgınlara yol açan fırsatçı Gram negatif basildir. Bu olgu sunumunda, Guillain-Barre sendromu nedeniyle hastanemizin nöroloji servisi yoğun bakım ünitesinde yatmakta iken 15 gün içerisinde değişik zamanlarda alınan üç seri kan kültür örneğinde B. cepacia üreyen, bağışıklık sistemi yeterli bir sepsis olgusu sunulmuştur. İzolatın, “Clinical and Laboratory Standards Institute CLSI ” kriterleri doğrultusunda Kirby-Bauer disk difüzyon yöntemiyle yapılan antibiyotik duyarlılık seftazidim ve meropeneme duyarlı, minosikline orta duyarlı olduğu tespit edilmiştir. Hastanın mevcut kolistin ve levofloksasin kombinasyon tedavisine doripenem eklenmiştir. Tedavinin üçüncü gününde ateş yanıtı alınan hastanın antibiyotik tedavisi 14 güne tamamlanmış, hasta tedavi bitiminde herhangi bir komplikasyon gelişmeksizin iyileşmiştir. Aynı dönemde nöroloji yoğun bakım ünitesinden kaynak araştırması amacıyla alınan çevresel örneklerin hiçbirisinden söz konusu etken üretilememiştir. Bağışıklık sisteminde sorun olmasa da uzun süre hastanede yatan, kataterli ve tıbbi cihazlara bağlı yoğun bakım ünitesi olgularında B. cepacia sepsisi görülebileceği akılda tutulmalıdır

Keywords

Guillain-Barre sendromu, hastane enfeksiyonu, sepsis, Burkholderia cepacia

Burkholderia cepacia sepsis observed in a hospitalized patient with Guillain-Barre syndrome

Abstract

Burkholderia cepacia, is an opportunistic Gramnegative bacillus that causes necrotizing pneumonia, sepsis/bacteremia and epidemics especially in cystic fibrosis or immunosupressed patients hospitalized in intensive care units. In this report, a case of B. cepacia sepsis in an immunocompetent patient with a diagnosis of Guillain-Barre syndrome hospitalized in the neurological intensive care unit, is being presented. B. cepacia was isolated from three serial blood cultures taken at different times within 15 days. The antibiotic susceptibility testing of the isolates was performed by Kirby-Bauer disc diffusion method according to the “Clinical and Laboratory Standards Institute CLSI ” criteria. The isolates were found to be susceptible to trimethoprim/sulfamethoxazole, ceftazidime and meropenem, and intermediately susceptible to minocycline. Doripenem was added to patient’s ongoing combination treatment with colistin and levofloxacin. On the third day of the treatment, the patient started having fever and therefore the antibiotic therapy was prolonged for additional 14 days. At the end of the therapy, the patient was cured without any complication. In the mean time, the agent could not be isolated from any other environmental samples taken from the neurological intensive care unit. It should be kept in mind that B. cepacia sepsis can be seen in intensive care unit patients with prolonged hospitalization, indwelling catheters and medical devices, even if they are not immunosupressed

Keywords

Guillain-Barre syndrome, nosocomial infection, sepsis, Burkholderia cepacia

References

• 1. Şener B. Kistik fibroziste mikrobiyal patogenez. Hacettepe Tıp Derg, 2002; 33(1): 49-57.
• 2. Horasanlı S, Tolun V, Küçüker MA. İdrardan izole edilen Burkholderia cepacia suşları. İnfeksiyon Derg, 1997; 11(4): 385-7.
• 3. Turan S, Ayık İ, Gömceli İ, Kazancı D, Polat Y, Öztürk B ve ark. Yoğun bakım ünitesinde nadir ve dirençli bir enfeksiyon; Burkholderia cepacia olgu sunumu. Ankara Üniv Tıp Fak Mecm, 2010; 63(4): 123-6.
• 4. Leitao JH, Sousa SA, Ferreira AS, Ramos CG, Silva IN, Moreira LM. Pathogenicity, virulence factors, and strategies to fight against Burkholderia cepacia complex pathogens and related species. Appl Microbiol Biotechnol, 2010; 87(1): 31-40.
• 5. Öztürk R. Çoklu ilaç dirençli Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophomonas maltophilia ile oluşan infeksiyon hastalıklarında antimikrobik tedavi. ANKEM Derg, 2008; 22(Ek sayısı 2): 36-43.
• 6. The Italian Guillain-Barre Study Group. The prognosis and main prognostic indicators of Guillain-Barre syndrome. A multicentre prospective study of 297 patients. Brain, 1996; 119(6): 2053-61.
• 7. Koruk ST, Bayraktar M, Koruk İ, Yılmaz L. Üriner sistoskop kontaminasyonu sonrası gelişen hastane kaynaklı Burkholderia cepacia salgını. ANKEM Derg, 2010; 24(4): 193-7.
• 8. Kaitwatcharachai C, Silpapojakul K, Jitsurong S, Kalnauwakul S. An outbreak of Burkholderia cepacia bacteremia in hemodialysis patients: an epidemiologic and molecular study. Am J Kidney Dis, 2000; 36(1): 199-204.
• 9. Hsieh WS, Sung LL, Tsai KC, Ho HT. Evaluation of the VITEK 2 cards for identification and antimicrobial susceptibility testing of non-glucose-fermenting Gram-negative bacilli. APMIS, 2009; 117(4): 241-7.
• 10. LiPuma JJ, Currie BJ, Lum GD, Vandamme PAR. Burkholderia, Stenotrophomonas, Ralstonia, Cupriavidus, Pandoreae, Brevundimonas, Comamonas, Delftia and Acidovorax. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, eds. Manual of Clinical Microbiology. 9th ed. Washington, DC. ASM Press, 2007: 749-69.
• 11. Kurtaran B, Saltoğlu N, İnal AS, Taşova Y, Özeren A. Nöroloji yoğun bakım ünitesinde hastane infeksiyonları. ANKEM Derg, 2005; 19(3): 119-24.
• 12. Clinical and Laboratory Standards Institute 2010: Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement. M100-s20, CLSI, M100-S20, Vol.30, No:1, Wayne, Pa, 2010.
• 13. Alvarez-Lerma F, Maull E, Terradas R, Segura C, Planells I, Coll P, et al. Moisturizing body milk as a reservoir of Burkholderia cepacia: Outbreak of nosocomial infection in a multidisciplinary intensive care unit. Crit Care, 2008; 12(1): 10.
• 14. Siddiqui AH, Mulligan ME, Mahenthiralingam E, Hebden J, Brewrink J, Qaiyumi S, et al. An episodic outbreak of genetically related Burkholderia cepacia among non-cystic fibrosis patients at a university hospital. Infect Control Hosp Epidemiol, 2001; 22(7): 419-22.
• 15. Berkelman RL, Lewin S, Allen JR, Anderson RL, Budnick LD, Shapiro S, et al. Pseudobacteremia attributed to contamination of povidone-iodine with Pseudomonas cepacia. Ann Intern Med, 1981; 95(1): 32-6.
• 16. Craven DE, Moody B, Connolly MG, Kollisch NR, Stottmeier KD, McCabe WR. Pseudobacteremia caused by povidone-iodine solution contaminated with Pseudomonas cepacia. N Engl J Med, 1981; 305(11): 621-3.
• 17. Panlilio AL, Beck-Sague CM, Siegel JD, Anderson RL, Yetts SY, Clark NC, et al. Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia. Clin Infect Dis, 1992; 14(5): 1078-83.
• 18. Kiska DL, Kerr A, Jones MC, Caracciolo JA, Eskridge B, Jordan M, et al. Accuracy of four commercial systems for identification of Burkholderia cepacia and other gram-negative nonfermenting bacilli recovered from patients with cystic fibrosis. J Clin Microbiol, 1996; 34(4): 886-91.
• 19. Brisse S, Stefani S, Verhoef J, Van Belkum A, Vandamme P, Goessens W. Comparative evaluation of the BD Phoenix and VITEK 2 automated instruments for identification of isolates of the Burkholderia cepacia complex. J Clin Microbiol, 2002; 40(5): 1743-8.
• 20. Şener B, Günalp A, Özçelik U, Göçmen A. Kistik fibrozis olgularının 5 yıllık mikrobiyolojik değerlendirimi. Mikrobiyol Bul, 1996; 30(4): 343-51.
• 21. Leitao JH, Sousa SA, Cunha MV, Salgado MJ, Melo-Cristino J, Barreto MC, et al. Variation of the antimicrobial susceptibility profiles of Burkholderia cepacia complex clonal isolates obtained from chronically infected cystic fibrosis patients: a five-year survey in the major Portuguese treatment center. Eur J Clin Microbiol Infect Dis, 2008; 27(11): 1101-11.