Burkholderia cepacia septicemia in a pediatric oncology patient: a pharmacotherapy challenge
Spencer H Durham1, Amy E Lee, Chatchawin Assanasen
1Sacred Heart Children's Hospital, Pensacola, FL, USA. durhash@gmail.com
Insights
Pharmacotherapy for Burkholderia cepacia septicemia in pediatric oncology patients presents challenges due to multidrug resistance and drug availability. Prompt recognition and tailored antibiotic treatment are crucial for survival.
Area of Science:
- Infectious Diseases
- Oncology
- Pharmacology
Background:
- Pediatric oncology patients, particularly those post-bone marrow transplant, are susceptible to severe infections.
- Burkholderia cepacia is an emerging multidrug-resistant pathogen causing septicemia in immunocompromised individuals.
Observation:
- A case of an 11-year-old male with aplastic anemia post-bone marrow transplant developed Burkholderia cepacia septicemia.
- Initial broad-spectrum antibiotics were ineffective; treatment was complicated by the unavailability of trimethoprim/sulfamethoxazole, a preferred agent.
- Infection resolution was achieved with central line removal and a tailored antibiotic regimen including ceftazidime and minocycline.
Findings:
- Burkholderia cepacia exhibits high-level antibiotic resistance, rendering commonly used empiric therapies for febrile neutropenia ineffective.
- Drug availability significantly impacts treatment options, necessitating adaptable pharmacotherapy strategies.
- Successful eradication required a multi-faceted approach, including source control (central line removal) and targeted antimicrobial agents.
Implications:
- This case highlights the critical need to consider Burkholderia cepacia in pediatric oncology patients with persistent infections unresponsive to standard treatment.
- Effective management necessitates early identification, susceptibility testing, and strategic pharmacotherapy, considering drug availability and resistance patterns.
- Optimal treatment of Burkholderia cepacia infections in immunocompromised hosts requires careful consideration of antibiotic resistance and potential drug shortages to prevent severe morbidity and mortality.
Objective:
To discuss pharmacotherapy challenges encountered during treatment of a pediatric oncology patient with Burkholderia cepacia septicemia.
Case Summary:
An 11-year-old male with a history of aplastic anemia presented to the emergency department with a 1-day history of cough and purulent nasal discharge 6 months after undergoing bone marrow transplant. Blood cultures obtained from the patient's Broviac catheter revealed gram-negative rods. Piperacillin/tazobactam and tobramycin were administered, but the patient worsened clinically, with fever and chills. B. cepacia was identified as the offending pathogen, and the therapy was changed to meropenem and ciprofloxacin, as piperacillin/ tazobactam and tobramycin are ineffective against Burkholderia spp. Intravenous trimethoprim/sulfamethoxazole, the drug of choice for Burkholderia spp. infections, was unavailable as it had been placed on national manufacturer backorder. The patient improved initially, but he later experienced recurrence of fever, and blood culture results were positive for Burkholderia spp. Infection was eradicated after removal of the central line and administration of ceftazidime and oral minocycline.
Discussion:
Literature reveals few cases of B. cepacia in pediatric oncology patients, and to our knowledge, no cases have been reported in bone marrow transplant patients in the US. Burkholderia spp. is highly resistant to many antibiotics, and commonly used agents for the empiric treatment of febrile neutropenia are not active against this organism. This indicates that most oncology patients who present with this infection would not receive appropriate initial treatment. In addition, antibiotic therapy may need to be modified, based on drug availability.
Conclusions:
B. cepacia is an emerging multidrug-resistant pathogen that can produce severe infection in immunocompromised patients. It is pertinent to consider this organism in oncology patients who do not improve with standard therapy, as prompt use of correct pharmacotherapy is necessary to avoid serious morbidity as well as mortality in this population.
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