Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016-2019

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• The Burkholderia cepacia complex (BCC) is an opportunistic pathogen.
• Infections in persons who inject drugs (PWID) can lead to severe morbidity and mortality.
• An increase in BCC infections among PWID in Hong Kong was observed.

Purpose of the Study:

• To describe the clinical features and molecular epidemiology of a BCC outbreak in PWID.
• To highlight the severity of BCC infections in this population.
• To recommend public health interventions for prevention and control.

Main Methods:

• Retrospective case series analysis of BCC infections in PWID from March 2016 to January 2019.
• Clinical data collection including infection types and treatment outcomes.
• Pulsed-field gel electrophoresis (PFGE) for molecular typing of BCC isolates.

Main Results:

• Thirteen PWID were diagnosed with BCC infections, including spondylitis, endocarditis, septic arthritis, abscess, bacteremia, and necrotizing fasciitis.
• A specific BCC clone was identified in 9 of the 13 patients, associated with severe illness.
• Eleven patients (85%) required surgical intervention due to the severity of infections.

Conclusions:

• BCC poses a significant threat to PWID, causing life-threatening infections that often necessitate surgery.
• Clinicians must maintain a high index of suspicion for BCC in PWID presenting with severe infections.
• Effective outbreak control requires collaboration between public health, social services, and healthcare providers, including methadone clinics.