A Case of Ceftazidime-Nonsusceptible Burkholderia pseudomallei Infection

Eunkyoung You; Mi Jeong Seo; Young Jin Kim; Myung Jae Park; Hee Joo Lee

doi:10.3343/lmo.2015.5.4.219

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You, Seo, Kim, Park, and Lee: A Case of Ceftazidime-Nonsusceptible Burkholderia pseudomallei Infection

Case Report

Clinical Microbiology

Laboratory Medicine Online 2015; 5(4): 219-222.

Published online: 1 October 2015

DOI: https://doi.org/10.3343/lmo.2015.5.4.219

A Case of Ceftazidime-Nonsusceptible Burkholderia pseudomallei Infection

Eunkyoung You, M.D.^1,^*, Mi Jeong Seo, M.T.^2,^*, Young Jin Kim, M.D.¹, Myung Jae Park, M.D.³, Hee Joo Lee, M.D.¹

¹Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.

²Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea.

³Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.

Corresponding author: Hee Joo Lee. Department of Laboratory Medicine, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemoon-gu, Seoul 02447, Korea. Tel: +82-2-958-8672, Fax: +82-2-958-8609, leehejo@khmc.or.kr

Equal contributor:

*These two authors contributed equally to this work.

Received 26 December 2014 Revised 15 April 2015 Accepted 15 April 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Melioidosis, which is an infectious disease caused by Burkholderia pseudomallei, is prevalent mostly in Southeast Asia and northern Australia; it can progress to abscess formation, pneumonia and sepsis, and ultimately cause death. A 66-yr-old male patient with diabetes mellitus was hospitalized for sepsis 3 months after coming back from Cambodia, and B. pseudomallei was identified from the blood culture. The B. pseudomallei strain was found to be susceptible to carbapenem, and non-susceptible to trimethoprim/sulfamethoxazole and ceftazidime. Although the patient was treated with carbapenem, to which the strain was susceptible, the bacteremia persisted, and progressed to septic shock and pneumonia, and eventually to acute respiratory distress syndrome (ARDS). The patient died on the 12th day of hospitalization. This study, which reports the first case of ceftazidime-nonsusceptible B. pseudomallei in Korea, indicates the importance of B. pseudomallei infection, which is highly likely to be imported to Korea, and discuss its clinical progress, which can lead to fatality.

Keywords: Burkholderia pseudomallei, Ceftazidime non-susceptible, Melioidosis

Figures and Tables

Fig. 1

Colonies on blood agar grew small, smooth and ordinary after 15 hr of incubation (A), but they turned into typical wrinkled appearance after 48 hr of incubation (B). On gram staining, B. pseudomallei is a gram negative rod with a characteristic "safety pin" appearance (C).

Table 1

Cases of B. psudomallei infection in Korea

Case No.	Year	Area visited	Nationality	Sex	Age	Riskfactor	Clinical diseases	Antimicrobial susceptibility test	Treatments	Outcome
1	2003	Indonesia	Korea	M	50	None	Pneumonia		CAZ → AMC	Survive
2	2004	Malaysia	Korea	M	47	DM	Pneumonia		CAZ ( → DOX) + SXT	Survive
3	2008	Thailand	Thailand	M	32	DM	Septic shock	S : CAZ, SXT, CIP, TZP, MEM R : CEPEPIME	Cefepime	Death (HD 3)
4	2009	Cambodia	Korea	M	47	DM	Pneumonia Septic shock	S : CAZ, IMI, CIP	Cefepime + azithromycin	Death (HD1)
5	2010	Malaysia	Korea	M	48	DM	Pneumonia Prostate abscess	S : CAZ, MEM, SXT	CAZ ( → MEM) + SXT	Survive
6	2010	Malaysia	Korea	M	55	None	Septic shock Neck abscess	S : CAZ, IMI, MEM, CIP R : SXT, Colistin	MEM	Death (HD 8)
7	2011	Philippine	Korea	M	N/A	Tb	Lung abscess			Survive
case	2013	Cambodia	Korea	M	66	DM	Septic shock	S : IMI R : CAZ, SXT	MEM	Death (HD 12)

Abbreviations: DM, diabetes mellitus; Tb, tuberculosis; S, susceptible; R, resistant; CAZ, ceftazidime; AMC, amoxicillin/clavulanic acid; DOX, doxycycline; SXT, trimethoprim-sulfamethoxazole; CIP, ciprofloxacin; TZP, piperacillin/tazobactam; MEM, meropenem; IMI, imipenem; HD, hospital days.

Notes

This article is available from http://www.labmedonline.org

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