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CASE REPORT
Refractory Burkholderia cepacia bacteraemia from a consolidation pneumonia lasting more than 7 weeks, successfully treated with systemic antibiotics and nebulised meropenem
  1. Bryan Albert Lim,
  2. Adelaine Lopez and
  3. Joseph Adrian Buensalido
  1. Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
  1. Correspondence to Dr Adelaine Lopez, ade.laine{at}yahoo.com

Abstract

We present a case of a 55-year-old Filipino man who was transferred from another institution where he was recently diagnosed with Crohn’s disease but not started on any immunosuppressants. He underwent laparoscopic cholecystectomy with T-tube placement a few weeks prior to admission. On workup, abdominal CT scan was unremarkable, but blood cultures on the third hospital day grew Burkholderia cepacia. Antibiotic regimen was shifted to ceftazidime and levofloxacin. The bacteraemia and febrile episodes persisted despite removal of the central line and T tube. White blood cell scan and chest CT scan showed left-sided consolidation pneumonia. Blood cultures continued to grow B. cepacia despite shifting to meropenem and trimethoprim-sulfamethoxazole. Meropenem nebulisation at 250 mg every 12 hours was added to the regimen on the third week then oral minocycline was added on the fourth week due to persistence of bacteraemia. He subsequently developed a small vegetation on the aortic valve, so amikacin was added. Fever lysed on the sixth week, but the B. cepacia bacteraemia persisted, clearing only on the 51st hospital day. The patient was discharged with a plan to continue antibiotics, including meropenem nebulisation, for 6 more weeks. On follow-up, the patient had no recurrence of fever. There was also resolution of consolidation on chest CT scan and disappearance of vegetation on echocardiography.

  • infections
  • infectious diseases
  • drugs: infectious diseases
  • pneumonia (infectious disease)
  • therapeutic indications
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Footnotes

  • Contributors BAL conducted extensive literature search on similar reported cases and contributed in the planning and conception of the discussion of the case. AL contributed in the reporting of the clinical course and acquisition of the diagnostic data. AL also conducted search of relevant literature for the discussion. JAB was involved in the conception and revision of the course and discussion of the case report. JAB also did a review of related literature. The diagnostic imaging included in this report was discussed with the radiologist by AL and JAB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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