Trend of Burkholderia cepacia complex bacteremia between 2008-2021: Insights from a Major Pakistani Laboratory Network

Background: Burkholderia cepacia complex (BCC) is an opportunistic pathogen, primarily affecting neonates and immunocompromised patients. Limited data exist in Pakistan on its prevalence and resistance patterns. This retrospective study aimed to assess trends of BCC infection and antimicrobial resistance from 2008 to 2021. Material and Methods: This retrospective study analyzed trends of Burkholderia cepacia complex (BCC) infections and their antimicrobial resistance at Aga Khan University Hospital, Pakistan, from 2008 to 2021. Antimicrobial susceptibility was tested using the Kirby–Bauer disc diffusion method against chloramphenicol, ceftazidime, ciprofloxacin, minocycline, meropenem, trimethoprim-sulfamethoxazole, and tetracycline, and interpreted per CLSI guidelines. Data were processed in SPSS version 19.0, with frequencies and percentages calculated to assess laboratory-confirmed BCC cases. Results: A total of 5411 BCC strains were isolated from blood cultures during a period of 2008–2021. We observed that neonates were the predominant age group (47-76%) almost each year for BCC bacteremia. This study observed highest resistance (up to 37%) in BCC strains against levofloxacin, isolated from both in-patients and out-patients. Higher meropenem resistance (37%) was found in in-patients isolates while 25% in out-patient isolates while ciprofloxacin resistance was higher (29% vs 20%) in outside referral blood cultures. Conclusions: Continuous surveillance of Burkholderia cepacia complex (BCC) antibacterial resistance is essential to monitor the spread of resistance, as antimicrobial resistance imparts a very crucial role in the spread of infection to susceptible group. Keywords: B. cepacia complex (BCC), Antimicrobial resistance, Neonates, Sepsis.