Catheter-Associated Burkholderia cenocepacia Infective Endocarditis in a Patient Receiving Maintenance Hemodialysis

Burkholderia cenocepacia, a member of the Burkholderia cepacia complex (BCC), is an opportunistic, intrinsically multidrug-resistant Gram-negative bacillus most commonly associated with nosocomial outbreaks and chronic pulmonary infection in patients with cystic fibrosis. Endocarditis caused by B. cenocepacia is extremely rare and has been reported mainly in intravenous drug users or in association with prosthetic valves. We report a fatal case of native mitral valve infective endocarditis caused by B. cenocepacia in a patient with end-stage renal disease (ESRD) receiving maintenance hemodialysis. A 50-year-old woman with diabetes mellitus, hypertension, and ESRD on hemodialysis had recently been treated for B. cenocepacia bacteremia, identified by MALDI-TOF MS, with a 2-week course of intravenous ceftazidime. During the same admission, thrombosis of her arteriovenous fistula necessitated placement of a central venous dialysis catheter. She represented shortly after discharge with altered mental status. Blood cultures obtained from both peripheral and central sites again yielded Gram-negative bacilli, with differential time to positivity suggesting a catheter-related source. The organism was identified as B. cenocepacia by MALDI-TOF mass spectrometry. Transthoracic echocardiography demonstrated a mobile mitral valve vegetation measuring 1.6 × 0.9 cm. Given extensive comorbidities and poor surgical candidacy, care was transitioned to palliation and the patient died during hospitalization. This case highlights the potential for B. cenocepacia to cause invasive endocardial infection in hemodialysis patients with indwelling central venous catheters.