Burkholderia pseudomallei

Note: Biohazard level III pathogen. Alert the laboratory if this organism is suspected.

Gram Stain

• Gram negative straight/slightly curved bacilli - nonfermenter (aerobic)

Clinical Significance

This organism is found in tropical climates of South East Asia, Northern Australia, and Africa. It is found in the soil and stagnant water.

It is associated with skin/soft tissue abscesses, bacteremia, pneumonia, and bone/joint infections.  It causes meliodosis which can be occur in 3 clinical forms:

1) acute – septicemia with metastatic lesions
2) subacute- pneumonia with cellulitis and lymphangitis
3) chronic- localized chronic cellulitis

Usual Susceptibility Pattern

This organism is usually susceptible to piperacillin-tazobactam, ceftazidime, carbapenems, amoxicillin-clavulanate, and doxycycline, and typically resistant to other  penicillins/cephalosporins, rifampin, fosfomycin, and aminoglycosides.

Quinolone and macrolide resistance is significant.

TMP/SMX susceptibility is variable (increased resistance if acquired in northern Thailand).

Resistance and/or relapse may occur if patient receives monotherapy.

Quinolones are associated with high rate of therapeutic failure.