P168 Eradication of Burkholderia cepacia in CF: time for a coordinated approach?

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Abstract

Introduction

New infection with Burkholderia cepacia complex (Bcc) organisms is a significant event for patients with cystic fibrosis (CF). In addition to potential clinical impact, there are implications for access to services and transplantation. Prior to developing a protocol for attempted eradication of Bcc, similar to that applied to Pseudomonas aeruginosa, UK CF centres were surveyed to establish what practices are currently employed.

Methods

A questionnaire was distributed to CF centre directors and non-returns followed up by email reminder.

Results

Responses were obtained from 35 units (73%). Because of the rarity of new Bcc infection in paediatric centres, only replies from 16 adult centres (representing 3400 patients) have been analysed further. 12 centres, representing 2860 patients, always attempt eradication of newly isolated Bcc. Two additional centres attempt eradication only in the presence of additional indications. Only two units had a formal eradication policy. IV antibiotics were used in all cases, for a median of 2 (range 2–6) weeks, typically comprising combined tobramycin and meropenem with additional therapy consisting of septrin (n=5), ceftazidime (6), and chloramphenicol (2). Nebulised antibiotics (typically tobramycin or meropenem) were also used in 13 of these 14 centres. Five units used additional oral antibiotics, for a median of 7 (2–12) weeks. This most commonly involved minocycline (n=4) and/or septrin (n=5). Two thirds of adult centres estimated success rate of eradication therapy to be <50%. In centres where eradication was not routine, factors that dissuaded clinicians were perceived poor success of treatment (n=5), toxicity (n=3), cost (n=1) and lack of experience with this approach (n=2).

Conclusions

Attempted eradication of newly acquired Bcc is controversial, involving expensive and potentially toxic therapies with no evidence to guide treatment choice and no published outcome data. Despite this, it is common practice in many UK adult CF centres. Most units do not have a formal eradication policy, adopting a variety of approaches, and estimates of treatment success are pessimistic. Since new acquisition of Bcc is now relatively rare, it is hard for even large units to assess response to therapies. A systematic approach is required to optimise and standardise treatment regimens, and assess outcomes.

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