Orhan BAYLAN, Tunçer HAZNEDAROĞLU, Oral ÖNCÜL, Semih ALAY, Mustafa ÖZYURT, Mehmet Burak SELEK

Guillain-Barre sendromu nedeniyle hastanede yatan bir hastada gelişen Burkholderia cepacia sepsisi

Burkholderia cepacia, yoğun bakım ünitelerinde takip edilen, özellikle kistik fibrozisli veya bağışıklık sistemi baskılanmış hastalarda nekrotizan pnömoni, sepsis/bakteriyemi ve salgınlara yol açan fırsatçı gram negatif basildir. Bu olgu sunumunda, Guillain-Barre sendromu nedeniyle hastanemizin nöroloji servisi yoğun bakım ünitesinde yatmakta iken 15 gün içerisinde değişik zamanlarda alınan üç seri kan kültür örneğinde B. cepacia üreyen, bağışıklık sistemi yeterli bir sepsis olgusu sunulmuştur. İzolatın, Clinical and Laboratory Standards Institute (CLSI) kriterleri doğrultusunda Kirby-Bauer disk difüzyon yöntemiyle yapılan antibiyotik duyarlılık testinde trimetoprim-sulfametaksazol, seftazidim ve meropeneme duyarlı, minosikline orta duyarlı olduğu tespit edilmiştir. Hastanın mevcut kolistin ve levofloksasin kombinasyon tedavisine doripenem eklenmiştir. Tedavinin üçüncü gününde ateş yanıtı alınan hastanın antibiyotik tedavisi 14 güne tamamlanmış, hasta tedavi bitiminde herhangi bir komplikasyon gelişmeksizin iyileşmiştir. Aynı dönemde nöroloji yoğun bakım ünitesinden kaynak araştırması amacıyla alınan çevresel örneklerin hiçbirisinden söz konusu etken üretilememiştir. Bağışıklık sisteminde sorun olmasa da uzun süre hastanede yatan, kataterli ve tıbbi cihazlara bağlı yoğun bakım ünitesi olgularında B. cepacia sepsis görülebileceği akılda tutulmalıdır.

Burkholderia cepacia sepsis observed in a hospitalized patient with Guillain-Barre syndrome

Department Of Infectious Diseases, Istanbul, TurkeyBurkholderia cepacia, is an opportunistic gram negative bacillus, that causes necrotizing pneumonia, sepsis/bacteremia and epidemics especially in cystic fibrosis or immunosupressed patients hospitalized in intensive care units. In this case report, we present a case of B. cepacia sepsis in an immunocompetent patient with a diagnosis of Guillain-Barre syndrome who was hospitalized in the neurological intensive care unit. B. cepacia was isolated from three blood culture sets taken one week apart. The antibiotic susceptibility testing of the isolates was performed by Kirby-Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) criteria. The isolates were found to be susceptible to trimethoprim/sulfamethoxazole, ceftazidime and meropenem, and intermediately susceptible to minocycline. Doripenem was added to his ongoing combination therapy with colistin and levofloxacin. On the third day of the treatment, fever response is acquired, antibiotic therapy was prolonged to 14 days and at the end of the therapy the patient was cured without any complications. In the mean time, the agent could not be isolated from any of the environmental samples that were taken from the neurological intensive care unit. B. cepacia sepsis can be seen in cases with prolonged hospitalization, indwelling catheters and bounded to medical devices in intensive care units, even if they are not immunosupressed.

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