Bacteremia Cases due to Burkholderia gladioli in ICU Sanglah General Hospital January-July 2015.
Five Bacteremia Cases due to Burkholderia gladioli
in ICU Sanglah General Hospital 2015
I Wayan Agus Gede Manik Saputra, Ni Nengah Dwi Fatmawati,
Ni Nyoman Sri Budayanti, Ni Made Adi Tarini
Department of Clinical Microbiology, Faculty of Medicine and Health Sciences, Udayana
University/Sanglah General Hospital Denpasar, Bali
Burkholderia gladioli is primarily a plant pathogen that can cause disease in severely
immunocompromised patients. According to Bergey’s Manual of Systemic Bacteriology it is
cathegorized into rRNA homology group II, not true pseudomonads and belongs to genus
Burkholderia. The phytopathogen B.gladioli has been most commonly associated with diseases
of the gladiolus plant and decaying onions. Bacteremia due to B.gladioli have never been
reported in Sanglah General Hospital. Five cases of bacteremia among four adult patients and
one child are reported in ICU Ward.
Three of them died because of severely
immunocompromised condition. The blood specimens were cultured in sheep blood agar and
MacConkey agar. A yellow pigmen colony yielded after 24 hours incubation, but the unique
pinky wrinkled colony will develop after more than five days incubation. The initial
identification of microorganism using Vitek2 system, but unfortunately this system could not
detect accurately due to the high phenotypic similarity between this species and closely related
species in the Burkholderia cepacia complex. After the isolates were identified as B. gladioli by
Vitek2 system, the confirmation was performed by using PCR. The antimicrobial susceptibility
pattern could not be gathered because the data was unavailable on Vitek2 system database. The
antimicrobial susceptibility test (ASTs) were then conducted based on Kirby Bauer Disk
Diffusion Methods. All AST results were analyzed using WHONET 5.6 version software. All
five isolated B.gladioli were confirmed as the same organism by using two oligonucleotide
primer pairs by PCR method. The origin of this bacterium, which caused an outbreak in ICU
ward needs further investigations, and infection control investigators must be enrolled on this
condition in order to prevent spreading this phytopathogen.
Keywords : Bacteremia, Burkholderia gladioli, ICU, Sanglah General Hospital PCR, Outbreak
References:
1. Mahon, C.R., Lehman, D.C., Manuselis, G. Textbook of Diagnostic Microbiology. 5th
Edition. China : Elsevier, Saunders.2015. P.486
2. Graves M, Robin T, Chipman AM, Wong J, Khashe S, Janda JM. Four Additional Cases of
Burkholderia gladioli infection with Microbiological Correlates and Review. Clinical
Infectious Diseases. 1997;25:838-42
3. Whitby PW, Pope LC, Carter KB, Lipuma JJ, Stull TL. Species-Specific PCR as a Tool for
the Identification of Burkholderia gladioli. Journal of Clinical Microbiology, Jan 2000,
p.282-285
1
4. Clode FE, Kaufmann ME, Malnick H, Pitt TL. Evaluation of three oligonucleotide primer
sets in PCR for the Identification of Burkholderia cepacia and their differentiation from
Burkholderia gladioli. J Clin Pathol 1999;52:173-176
2
in ICU Sanglah General Hospital 2015
I Wayan Agus Gede Manik Saputra, Ni Nengah Dwi Fatmawati,
Ni Nyoman Sri Budayanti, Ni Made Adi Tarini
Department of Clinical Microbiology, Faculty of Medicine and Health Sciences, Udayana
University/Sanglah General Hospital Denpasar, Bali
Burkholderia gladioli is primarily a plant pathogen that can cause disease in severely
immunocompromised patients. According to Bergey’s Manual of Systemic Bacteriology it is
cathegorized into rRNA homology group II, not true pseudomonads and belongs to genus
Burkholderia. The phytopathogen B.gladioli has been most commonly associated with diseases
of the gladiolus plant and decaying onions. Bacteremia due to B.gladioli have never been
reported in Sanglah General Hospital. Five cases of bacteremia among four adult patients and
one child are reported in ICU Ward.
Three of them died because of severely
immunocompromised condition. The blood specimens were cultured in sheep blood agar and
MacConkey agar. A yellow pigmen colony yielded after 24 hours incubation, but the unique
pinky wrinkled colony will develop after more than five days incubation. The initial
identification of microorganism using Vitek2 system, but unfortunately this system could not
detect accurately due to the high phenotypic similarity between this species and closely related
species in the Burkholderia cepacia complex. After the isolates were identified as B. gladioli by
Vitek2 system, the confirmation was performed by using PCR. The antimicrobial susceptibility
pattern could not be gathered because the data was unavailable on Vitek2 system database. The
antimicrobial susceptibility test (ASTs) were then conducted based on Kirby Bauer Disk
Diffusion Methods. All AST results were analyzed using WHONET 5.6 version software. All
five isolated B.gladioli were confirmed as the same organism by using two oligonucleotide
primer pairs by PCR method. The origin of this bacterium, which caused an outbreak in ICU
ward needs further investigations, and infection control investigators must be enrolled on this
condition in order to prevent spreading this phytopathogen.
Keywords : Bacteremia, Burkholderia gladioli, ICU, Sanglah General Hospital PCR, Outbreak
References:
1. Mahon, C.R., Lehman, D.C., Manuselis, G. Textbook of Diagnostic Microbiology. 5th
Edition. China : Elsevier, Saunders.2015. P.486
2. Graves M, Robin T, Chipman AM, Wong J, Khashe S, Janda JM. Four Additional Cases of
Burkholderia gladioli infection with Microbiological Correlates and Review. Clinical
Infectious Diseases. 1997;25:838-42
3. Whitby PW, Pope LC, Carter KB, Lipuma JJ, Stull TL. Species-Specific PCR as a Tool for
the Identification of Burkholderia gladioli. Journal of Clinical Microbiology, Jan 2000,
p.282-285
1
4. Clode FE, Kaufmann ME, Malnick H, Pitt TL. Evaluation of three oligonucleotide primer
sets in PCR for the Identification of Burkholderia cepacia and their differentiation from
Burkholderia gladioli. J Clin Pathol 1999;52:173-176
2