Therapeutic options for Burkholderia cepacia infections beyond co-trimoxazole: a systematic review of the clinical evidence

International Journal of Antimicrobial Agents

Volumn 33, Issue 5, 2009, Pages 394-404

  Avgeri, Sophia G ^a   Matthaiou, Dimitrios K ^a   Dimopoulos, George ^a,b   Grammatikos, Alexandros P ^c   Falagas, Matthew E ^a,d,e  

^a ALFA INSTITUTE OF BIOMEDICAL SCIENCES AIBS   (Greece)

^b Medical School   (Greece)

^c G GENNIMATAS GENERAL HOSPITAL   (Greece)

^d TUFTS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e HENRY DUNANT HOSPITAL   (Greece)

Author keywords

Ceftazidime; Cystic fibrosis; Meropenem; Piperacillin; Pseudomonas

Indexed keywords

AMOXICILLIN PLUS CLAVULANIC ACID; AZTREONAM; CARBENICILLIN; CEFEPIME; CEFOPERAZONE; CEFTAZIDIME; CHLORAMPHENICOL; CIPROFLOXACIN; CLINAFLOXACIN; COLISTIN; COTRIMOXAZOLE; GENTAMICIN; IMIPENEM; KANAMYCIN; LEVOFLOXACIN; LINCOMYCIN; MEROPENEM; METRONIDAZOLE; MINOCYCLINE; NALIDIXIC ACID; PENICILLIN DERIVATIVE; PIPERACILLIN; RIFAMPICIN; SULFADIAZINE; SULFAFURAZOLE; SULPERAZON; TETRACYCLINE; TOBRAMYCIN; UNINDEXED DRUG; VANCOMYCIN;

ABSCESS; ACUTE PYELONEPHRITIS; ANTIBIOTIC SENSITIVITY; BACTEREMIA; BACTERIAL ARTHRITIS; BRAIN ABSCESS; BURKHOLDERIA CEPACIA; BURKHOLDERIA CEPACIA COMPLEX; BURKHOLDERIA CEPACIA INFECTION; CYSTIC FIBROSIS; DEVICE INFECTION; DRUG HYPERSENSITIVITY; DRUG INDICATION; DRUG TREATMENT FAILURE; ECTHYMA; ENDOCARDITIS; ENDOPHTHALMITIS; EXTERNAL OTITIS; HUMAN; INFECTION PREVENTION; LIVER ABSCESS; LUNG ABSCESS; LYMPHADENITIS; MEDIASTINITIS; MENINGITIS; MONOTHERAPY; NECROTIZING FASCIITIS; NONHUMAN; NOSE INFECTION; OSTEOMYELITIS; PERITONITIS; PLEURA EFFUSION; PLEURA EMPYEMA; PNEUMONIA; PRIORITY JOURNAL; PROSTATITIS; RECURRENT INFECTION; RESPIRATORY TRACT INFECTION; SEPSIS; SEPTIC SHOCK; SEPTICEMIA; SHORT SURVEY; SUBDURAL EMPYEMA; SYSTEMATIC REVIEW; TREATMENT OUTCOME; TREATMENT RESPONSE; URINARY TRACT INFECTION; VAGINITIS;

ANTI-BACTERIAL AGENTS; BURKHOLDERIA CEPACIA COMPLEX; BURKHOLDERIA INFECTIONS; DRUG THERAPY, COMBINATION; HUMANS; TREATMENT OUTCOME; TRIMETHOPRIM-SULFAMETHOXAZOLE COMBINATION;

EID: 62949084516     PISSN: 09248579     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ijantimicag.2008.09.010     Document Type: Short Survey

References (110)

1. Govan J.R., Hughes J.E., and Vandamme P. Burkholderia cepacia: medical, taxonomic and ecological issues. J Med Microbiol 45 (1996) 395-407
2. Mortensen J.E., Fisher M.C., and LiPuma J.J. Recovery of Pseudomonas cepacia and other Pseudomonas species from the environment. Infect Control Hosp Epidemiol 16 (1995) 30-32
3. Burkholder W.H. Sour skin, a bacterial rot of onion bulbs. Phytopathology 40 (1950) 115-117
4. Bottone E.J., Douglas S.D., Rausen A.R., and Keusch G.T. Association of Pseudomonas cepacia with chronic granulomatous disease. J Clin Microbiol 1 (1975) 425-428
5. Saiman L., and Siegel J. Infection control in cystic fibrosis. Clin Microbiol Rev 17 (2004) 57-71
6. Tablan O.C., Chorba T.L., Schidlow D.V., White J.W., Hardy K.A., Gilligan P.H., et al. Pseudomonas cepacia colonization in patients with cystic fibrosis: risk factors and clinical outcome. J Pediatr 107 (1985) 382-387
7. Conly J.M., Klass L., Larson L., Kennedy J., Low D.E., and Harding G.K. Pseudomonas cepacia colonization and infection in intensive care units. CMAJ 134 (1986) 363-366
8. Pegues D.A., Carson L.A., Anderson R.L., Norgard M.J., Argent T.A., Jarvis W.R., et al. Outbreak of Pseudomonas cepacia bacteremia in oncology patients. Clin Infect Dis 16 (1993) 407-411
9. Noriega E.R., Rubinstein E., Simberkoff M.S., and Rahal J.J. Subacute and acute endocarditis due to Pseudomonas cepacia in heroin addicts. Am J Med 59 (1975) 29-36
10. Speller D.C. Pseudomonas cepacia endocarditis treated with co-trimoxazole and kanamycin. Br Heart J 35 (1973) 47-48
11. Eser I., Altan T., Stahl J.E., Aydin M.D., Inan N., Kapran Z., et al. Two cases of Burkholderia cepacia endophthalmitis. Br J Ophthalmol 90 (2006) 1211
12. Yilmaz T., Celik I., Cihangiroglu M., Yildirim S., and Akbulut A. Burkholderia cepacia: an unusual cause of postoperative endophthalmitis. Asian J Ophthalmol 8 (2006) 121-123
13. Al Attia H.M., Qureshi R.A., and El Hag I.A. Skull osteomyelitis and multiple brain abscesses. Postgrad Med J 76 (2000) 124
14. Balfour-Lynn I.M., Ryley H.C., and Whitehead B.F. Subdural empyema due to Burkholderia cepacia: an unusual complication after lung transplantation for cystic fibrosis. J R Soc Med 90 Suppl. 31 (1997) 59-64
15. Hobson R., Gould I., and Govan J. Burkholderia (Pseudomonas) cepacia as a cause of brain abscesses secondary to chronic suppurative otitis media. Eur J Clin Microbiol Infect Dis 14 (1995) 908-911
16. Burns J.L., Emerson J., Stapp J.R., Yim D.L., Krzewinski J., Louden L., et al. Microbiology of sputum from patients at cystic fibrosis centers in the United States. Clin Infect Dis 27 (1998) 158-163
17. Dakin C.J., Numa A.H., Wang H., Morton J.R., Vertzyas C.C., and Henry R.L. Inflammation, infection, and pulmonary function in infants and young children with cystic fibrosis. Am J Respir Crit Care Med 165 (2002) 904-910
18. Rajan S., and Saiman L. Pulmonary infections in patients with cystic fibrosis. Semin Respir Infect 17 (2002) 47-56
19. Mahenthiralingam E., Vandamme P., Campbell M.E., Henry D.A., Gravelle A.M., Wong L.T., et al. Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans. Clin Infect Dis 33 (2001) 1469-1475
20. Ramsey B.W. Management of pulmonary disease in patients with cystic fibrosis. N Engl J Med 335 (1996) 179-188
21. Banerjee D., and Stableforth D. The treatment of respiratory Pseudomonas infection in cystic fibrosis: what drug and which way?. Drugs 60 (2000) 1053-1064
22. Lewin C., Doherty C., and Govan J. In vitro activities of meropenem, PD 127391, PD 131628, ceftazidime, chloramphenicol, co-trimoxazole, and ciprofloxacin against Pseudomonas cepacia. Antimicrob Agents Chemother 37 (1993) 123-125
23. Nord C.E., Wadstrom T., and Wretlind B. Synergistic effect of combinations of sulfamethoxazole, trimethoprim, and colistin against Pseudomonas maltophilia and Pseudomonas cepacia. Antimicrob Agents Chemother 6 (1974) 521-523
24. Aaron S.D., Ferris W., Henry D.A., Speert D.P., and Macdonald N.E. Multiple combination bactericidal antibiotic testing for patients with cystic fibrosis infected with Burkholderia cepacia. Am J Respir Crit Care Med 161 (2000) 1206-1212
25. Anonymous. Pseudomonas cepacia-more than a harmless commensal? Lancet 1992; 339:1385-6.
26. Aggarwal N., Garg S., Pannu H.S., and Kler T.S. Fatal Burkholderia cepacia early prosthetic valve endocarditis: a very rare case and a review of the literature. J Heart Valve Dis 14 (2005) 271-274
27. Blumer J.L., Stern R.C., Klinger J.D., Yamashita T.S., Meyers C.M., Blum A., et al. Ceftazidime therapy in patients with cystic fibrosis and multiply-drug-resistant Pseudomonas. Am J Med 79 (1985) 37-46
28. Ederer G.M., and Matsen J.M. Colonization and infection with Pseudomonas cepacia. J Infect Dis 125 (1972) 613-618
29. Isles A., Maclusky I., Corey M., Gold R., Prober C., Fleming P., et al. Pseudomonas cepacia infection in cystic fibrosis: an emerging problem. J Pediatr 104 (1984) 206-210
30. Martone W.J., Osterman C.A., Fisher K.A., and Wenzel R.P. Pseudomonas cepacia: implications and control of epidemic nosocomial colonization. Rev Infect Dis 3 (1981) 708-715
31. Moore R.A., and Hancock R.E. Involvement of outer membrane of Pseudomonas cepacia in aminoglycoside and polymyxin resistance. Antimicrob Agents Chemother 30 (1986) 923-926
32. Lekstrom-Himes J.A., and Gallin J.I. Immunodeficiency diseases caused by defects in phagocytes. N Engl J Med 343 (2000) 1703-1714
33. Margolis D.M., Melnick D.A., Alling D.W., and Gallin J.I. Trimethoprim-sulfamethoxazole prophylaxis in the management of chronic granulomatous disease. J Infect Dis 162 (1990) 723-726
34. McGowan J.E. Resistance in nonfermenting Gram-negative bacteria: multidrug resistance to the maximum. Am J Infect Control 34 (2006) 29-37
35. Berry M.D., and Asmar B.I. Pseudomonas cepacia bacteremia in children with sickle cell hemoglobinopathies. Pediatr Infect Dis J 10 (1991) 696-699
36. Brescia G., Pavin A., Rinaldi R., Marioni G., and Staffieri A. Burkholderia cepacia complex infection in a case of sinonasal polyposis recurrence without cystic fibrosis. Auris Nasus Larynx 35 (2008) 414-416
37. Cabrera H.A., and Drake M.A. An epidemic in a coronary care unit caused by Pseudomonas species. Am J Clin Pathol 64 (1975) 700-704
38. Del Piero E., Pennett M., and Leopold I. Pseudomonas cepacia endophthalmitis. Ann Ophthalmol 17 (1985) 753-756
39. Dettelbach M.A., Hirsch B.E., and Weissman J.L. Pseudomonas cepacia of the temporal bone: malignant external otitis in a patient with cystic fibrosis. Otolaryngol Head Neck Surg 111 (1994) 528-532
40. Duan X., Ling F., Zhou L., Yu Z., Ren S.H., and Zhou T.M. Pacemaker generator pocket infection due to Burkholderia cepacia. J Hosp Infect 67 (2007) 392-393
41. Fadini G.P., Tiengo A., and Avogaro A. First isolation of Burkholderia cepacia from a deep neck abscess in a diabetic patient successfully treated with hyperbaric oxygen. J Clin Microbiol 43 (2005) 529
42. George R.B., Cartier Y., Casson A.G., and Hernandez P. Suppurative mediastinitis secondary to Burkholderia cepacia in a patient with cystic fibrosis. Can Respir J 13 (2006) 215-218
43. Gerrits G.P., Klaassen C., Coenye T., Vandamme P., and Meis J.F. Burkholderia fungorum septicemia. Emerg Infect Dis 11 (2005) 1115-1117
44. Guglierame P., Pasca M.R., De Rossi E., Buroni S., Arrigo P., Manina G., et al. Life-threatening sepsis caused by Burkholderia cepacia from contaminated intravenous flush solutions prepared by a compounding pharmacy in another state. Pediatrics 118 (2006) 212-215
45. Hsu C.-C., Liu Y.-P., Lien W.-C., Lai T.-I., Chen W.-J., and Wang H.-P. Urachal abscess: a cause of adult abdominal pain that cannot be ignored. Am J Emerg Med 23 (2005) 229-230
46. Hsu C.-C., Liu Y.-P., Lien W.-C., Lai T.-I., Chen W.-J., and Wang H.-P. Chronic granulomatous disease: a case report. J Formos Med Assoc 100 (2001) 281-284
47. Jeffries I.P., Torres A., and Andrade E. Burkholderia cepacia infection in a neonate. Int Pediatr 12 (1997) 144-145
48. Kahyaoglu O., Nolan B., and Kumar A. Burkholderia cepacia sepsis in neonates. Pediatr Infect Dis J 14 (1995) 815-816
49. Kothari T., Reyes M.P., and Brooks N. Pseudomonas cepacia septic arthritis due to intra-articular injections of methylprednisolone. Can Med Assoc J 116 (1977) 1230
50. Kuti J.L., Moss K.M., Nicolau D.P., and Knauft R.F. Empiric treatment of multidrug-resistant Burkholderia cepacia lung exacerbation in a patient with cystic fibrosis: application of pharmacodynamic concepts to meropenem therapy. Pharmacotherapy 24 (2004) 1641-1645
51. Lau S.M., Yu W.L., and Wang J.H. Cardiac cirrhosis with cellulitis caused by Burkholderia cepacia bacteremia. Clin Infect Dis 29 (1999) 447-448
52. Li F.K., Chan K.W., Chan T.M., and Lai K.N. Burkholderia urinary tract infection after renal transplantation. Transpl Infect Dis 5 (2003) 59-61
53. Lukela M., DeGuzman D., Weinberger S., and Saint S. Clinical problem-solving. Unfashionably late. N Engl J Med 352 (2005) 64-69
54. Mandell I.N., Feiner H.D., Price N.M., and Simberkoff M. Pseudomonas cepacia endocarditis and ecthyma gangrenosum. Arch Dermatol 113 (1977) 199-202
55. Marioni G., Rinaldi R., Ottaviano G., Marchese-Ragona R., Savastano M., and Staffieri A. Cervical necrotizing fasciitis: a novel clinical presentation of Burkholderia cepacia infection. J Infect 53 (2006) 219-222
56. Marioni G., Rinaldi R., Ottaviano G., Marchese-Ragona R., Savastano M., and Staffieri A. Ceftazidime in the therapy of pseudomonal meningitis. Chemioterapia 4 (1985) 289-292
57. Matteson E.L., and McCune W.J. Septic arthritis caused by treatment resistant Pseudomonas cepacia. Ann Rheum Dis 49 (1990) 258-259
58. Miki R.A., Rubin L.E., Kirk J., and Dodds S.D. Spontaneous septic arthritis caused by Burkholderia cepacia. Iowa Orthop J 26 (2006) 147-150
59. Mukhopadhyay C., Bhargava A., and Ayyagari A. Two novel clinical presentations of Burkholderia cepacia infection. J Clin Microbiol 42 (2004) 3904-3905
60. Noyes B.E., Michaels M.G., Kurland G., Armitage J.M., and Orenstein D.M. Pseudomonas cepacia empyema necessitatis after lung transplantation in two patients with cystic fibrosis. Chest 105 (1994) 1888-1891
61. Pathengay A., Raju B., Sharma S., and Das T. Recurrent endophthalmitis caused by Burkholderia cepacia. Eye 19 (2005) 358-359
62. Pathengay A., Raju B., Sharma S., and Das T. Burkholderia cenocepacia vaginal infection in patient with smoldering myeloma and chronic hepatitis C. Emerg Infect Dis 10 (2004) 1957-1959
63. Phillips I., Eykyn S., Curtis M.A., and Snell J.J. Pseudomonas cepacia (multivorans) septicaemia in an intensive-care unit. Lancet 1 (1971) 375-377
64. Poe R.H., Marcus H.R., and Emerson G.L. Lung abscess due to Pseudomonas cepacia. Am Rev Respir Dis 115 (1977) 861-865
65. Saha S.K., Hanif M., Khan W.A., Rahaman D., Khan N., Hoq M.S., et al. Fatal sepsis due to Pseudomonas cepacia. Singapore Med J 35 (1994) 475-476
66. Sieber O.F., and Fulginiti V.A. Pseudomonas cepacia pneumonia in a child with chronic granulomatous disease and selective IgA deficiency. Acta Paediatr Scand 65 (1976) 519-520
67. Simmonds E.J., Conway S.P., Ghoneim A.T., Ross H., and Littlewood J.M. Pseudomonas cepacia: a new pathogen in patients with cystic fibrosis referred to a large centre in the United Kingdom. Arch Dis Child 65 (1990) 874-877
68. Teng L.J., Hsueh P.R., Pan H.J., Ho S.W., and Luh K.T. Persistent bacteraemia caused by a single clone of Burkholderia cepacia with unusual phenotype. J Infect 42 (2001) 202-205
69. Thong M.L., and Tay L.K. Septicaemia from prolonged intravenous infusions. Arch Dis Child 50 (1975) 886-889
70. Trujillo E., Herrero J.I., and Moyano C. Burkholderia cepacia pneumonia in a patient with common variable immunodeficiency. Arch Bronconeumol 39 (2003) 239-240 [in Spanish]
71. Waterer G.W., Jones C.B., and Wunderink R.G. Bacteremic community-acquired pneumonia in an immunocompetent adult due to Burkholderia cepacia. Chest 116 (1999) 1842-1843
72. Weinstein A.J., Moellering R.C., Hopkins C.C., and Goldblatt A. Pseudomonas cepacia pneumonia. Am J Med Sci 265 (1973) 491-494
73. Whitehouse J.L., Exley A.R., Foweraker J., and Bilton D. Chronic Burkholderia multivorans bronchial infection in a non-cystic fibrosis individual with mannose binding lectin deficiency. Thorax 60 (2005) 168-170
74. Wilson D.L., Owens R.C., and Zuckerman J.B. Successful meropenem desensitization in a patient with cystic fibrosis. Ann Pharmacother 37 (2003) 1424-1428
75. Yu H.P., Tang G.J., Liaw W.J., Yien H.W., and Lee T.Y. Pseudomonas cepacia induced septic shock after propofol-a case report. Acta Anaesthesiol Sin 38 (2000) 53-56
76. Koppel B.S., Daras M., and Duffy K.R. Intramedullary spinal cord abscess. Neurosurgery 26 (1990) 145-146
77. Berkelman R.L., Godley J., Weber J.A., Anderson R.L., Lerner A.M., Petersen N.J., et al. Pseudomonas cepacia peritonitis associated with contamination of automatic peritoneal dialysis machines. Ann Intern Med 96 (1982) 456-458
78. Huang C.H., Jang T.N., Liu C.Y., Fung C.P., Yu K.W., and Wong W.W. Characteristics of patients with Burkholderia cepacia bacteremia. J Microbiol Immunol Infect 34 (2001) 215-219
79. Keizur J.J., Lavin B., and Leidich R.B. Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate. J Urol 149 (1993) 523-526
80. Gold R., Jin E., Levison H., Isles A., and Fleming P.C. Ceftazidime alone and in combination in patients with cystic fibrosis: lack of efficacy in treatment of severe respiratory infections caused by Pseudomonas cepacia. J Antimicrob Chemother 12 Suppl. A (1983) 331-336
81. Goldfarb J., Stern R.C., Reed M.D., Yamashita T.S., Myers C.M., and Blumer J.L. Ciprofloxacin monotherapy for acute pulmonary exacerbations of cystic fibrosis. Am J Med 82 (1987) 174-179
82. Ciofu O., Jensen T., Pressler T., Johansen H.K., Koch C., and Hoiby N. Meropenem in cystic fibrosis patients infected with resistant Pseudomonas aeruginosa or Burkholderia cepacia and with hypersensitivity to beta-lactam antibiotics. Clin Microbiol Infect 2 (1996) 91-98
83. Taylor R.F., Gaya H., and Hodson M.E. Temocillin and cystic fibrosis: outcome of intravenous administration in patients infected with Pseudomonas cepacia. J Antimicrob Chemother 29 (1992) 341-344
84. Gold R., Carpenter S., Heurter H., Corey M., and Levison H. Randomized trial of ceftazidime versus placebo in the management of acute respiratory exacerbations in patients with cystic fibrosis. J Pediatr 111 (1987) 907-913
85. Gilligan P.H. Microbiology of airway disease in patients with cystic fibrosis. Clin Microbiol Rev 4 (1991) 35-51
86. Wilkinson S.G., and Pitt T.L. Burkholderia (Pseudomonas) cepacia: pathogenicity and resistance. Rev Med Microbiol 6 (1995) 10
87. Burns J.L., Hedin L.A., and Lien D.M. Chloramphenicol resistance in Pseudomonas cepacia because of decreased permeability. Antimicrob Agents Chemother 33 (1989) 136-141
88. Guglierame P., Pasca M.R., De Rossi E., Buroni S., Arrigo P., Manina G., et al. Efflux pump genes of the resistance-nodulation-division family in Burkholderia cenocepacia genome. BMC Microbiol 6 (2006) 66
89. Burns J.L., Wadsworth C.D., Barry J.J., and Goodall C.P. Nucleotide sequence analysis of a gene from Burkholderia (Pseudomonas) cepacia encoding an outer membrane lipoprotein involved in multiple antibiotic resistance. Antimicrob Agents Chemother 40 (1996) 307-313
90. Poole K. Multidrug efflux pumps and antimicrobial resistance in Pseudomonas aeruginosa and related organisms. J Mol Microbiol Biotechnol 3 (2001) 255-264
91. Trépanier S., Prince A., and Huletsky A. Characterization of the penA and penR genes of Burkholderia cepacia 249 which encode the chromosomal class A penicillinase and its LysR-type transcriptional regulator. Antimicrob Agents Chemother 41 (1997) 2399-2405
92. Parr T.R., Moore R.A., Moore L.V., and Hancock R.E. Role of porins in intrinsic antibiotic resistance of Pseudomonas cepacia. Antimicrob Agents Chemother 31 (1987) 121-123
93. Burns J.L., Lien D.M., and Hedin L.A. Isolation and characterization of dihydrofolate reductase from trimethoprim-susceptible and trimethoprim-resistant Pseudomonas cepacia. Antimicrob Agents Chemother 33 (1989) 1247-1251
94. Conway S.P., Brownlee K.G., Denton M., and Peckham D.G. Antibiotic treatment of multidrug-resistant organisms in cystic fibrosis. Am J Respir Med 2 (2003) 321-332
95. Aronoff S.C. Outer membrane permeability in Pseudomonas cepacia: diminished porin content in a beta-lactam-resistant mutant and in resistant cystic fibrosis isolates. Antimicrob Agents Chemother 32 (1988) 1636-1639
96. Lyczak J.B., Cannon C.L., and Pier G.B. Lung infections associated with cystic fibrosis. Clin Microbiol Rev 15 (2002) 194-222
97. Abe K., D'Angelo M.T., Sunenshine R., Noble-Wang J., Cope J., Jensen B., et al. Outbreak of Burkholderia cepacia bloodstream infection at an outpatient hematology and oncology practice. Infect Control Hosp Epidemiol 28 (2007) 1311-1313
98. Bureau-Chalot F., Piednoir E., Pierrat C., Santerne B., and Bajolet O. Nosocomial Burkholderia cepacia outbreak in an intensive pediatric care unit. Arch Pediatr 10 (2003) 882-886 [in French]
99. Spencer R.C. The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect 30 Suppl. (1995) 453-464
100. Anderson R.L., Vess R.W., Panlilio A.L., and Favero M.S. Prolonged survival of Pseudomonas cepacia in commercially manufactured povidone-iodine. Appl Environ Microbiol 56 (1990) 3598-3600
101. Berthelot P., Grattard F., Mahul P., Jospe R., Pozzetto B., Ros A., et al. Ventilator temperature sensors: an unusual source of Pseudomonas cepacia in nosocomial infection. J Hosp Infect 25 (1993) 33-43
102. Lu D.C., Chang S.C., Chen Y.C., Luh K.T., Lee C.Y., and Hsieh W.C. Burkholderia cepacia bacteremia: a retrospective analysis of 70 episodes. J Formos Med Assoc 96 (1997) 972-978
103. Panlilio A.L., Beck-Sague C.M., Siegel J.D., Anderson R.L., Yetts S.Y., Clark N.C., et al. Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia. Clin Infect Dis 14 (1992) 1078-1083
104. Pegues C.F., Pegues D.A., Ford D.S., Hibberd P.L., Carson L.A., Raine C.M., et al. Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak. Epidemiol Infect 116 (1996) 309-317
105. Sobel J.D., Hashman N., Reinherz G., and Merzbach D. Nosocomial Pseudomonas cepacia infection associated with chlorhexidine contamination. Am J Med 73 (1982) 183-186
106. Takigawa K., Fujita J., Negayama K., Yamagishi Y., Yamaji Y., Ouchi K., et al. Nosocomial outbreak of Pseudomonas cepacia respiratory infection in immunocompromised patients associated with contaminated nebulizer devices. Kansenshogaku Zasshi 67 (1993) 1115-1125
107. Weems J.J. Nosocomial outbreak of Pseudomonas cepacia associated with contamination of reusable electronic ventilator temperature probes. Infect Control Hosp Epidemiol 14 (1993) 583-586
108. Donlan R.M. Biofilms: microbial life on surfaces. Emerg Infect Dis 8 (2002) 881-890
109. Gibson R.L., Burns J.L., and Ramsey B.W. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 168 (2003) 918-925
110. Aaron S.D., Vandemheen K.L., Ferris W., Fergusson D., Tullis E., Haase D., et al. Combination antibiotic susceptibility testing to treat exacerbations of cystic fibrosis associated with multiresistant bacteria: a randomised, double-blind, controlled clinical trial. Lancet 366 (2005) 463-471