ASSESSING THE BURDEN OF BURKHOLDERIA CEPACIA COMPLEX IN ICU PATIENTS: IMPLICATIONS FOR ANTIMICROBIAL STEWARDSHIP

Abstract

Background: Burkholderia cepacia complex (Bcc) is an opportunistic, non-fermenting gram-negative bacillus increasingly recognized as an important healthcare-associated pathogen in critically ill patients. Its ability to survive in hospital environments, intrinsic resistance to multiple antimicrobials, and association with prolonged hospital stay make it a significant concern in intensive care units (ICUs). Limited data are available regarding the burden and antimicrobial susceptibility profile of Bcc among adult ICU patients in tertiary care settings of Bihar, India. Understanding its prevalence and resistance pattern is essential for guiding infection control strategies and antimicrobial stewardship practices. Aim: To assess the burden of Burkholderia cepacia complex among ICU patients and to evaluate its antimicrobial susceptibility profile, with special reference to its implications for antimicrobial stewardship. Materials and Methods: A hospital-based cross-sectional study was conducted among 312 adult patients admitted to the ICU of a selected tertiary care hospital in Bihar. Patients above 18 years of age undergoing microbiological analysis of body fluid samples were included. Samples such as blood, urine, sputum, cerebrospinal fluid, ascitic fluid, and other body fluids were collected according to standard operating procedures and processed in the microbiology laboratory. Identification of microorganisms and antimicrobial susceptibility testing were performed using the automated VITEK 2 Compact 30 system. Data were analyzed using SPSS and MS Excel. Categorical variables were expressed as frequency and percentage, and appropriate statistical tests were applied, with p<0.05 considered statistically significant. Results: Among the 312 ICU patients, the majority belonged to the 31–50 years age group (39.74%), and males constituted 61.54% of the study population. Most patients were admitted to the Medical ICU (57.05%), and 65.38% had associated comorbidities. Blood samples formed the largest proportion of specimens (32.69%), while culture positivity was highest in sputum samples (55.56%). The overall prevalence of Bcc infection was 3.53% (11/312). Among Bcc-positive isolates, sputum was the most common source (36.36%), followed by blood (27.27%) and urine (18.18%). Presence of comorbidities showed a statistically significant association with Bcc infection (p=0.048). Trimethoprim-sulfamethoxazole showed the highest sensitivity (81.82%), followed by levofloxacin (72.73%). Bcc-positive patients had a significantly longer ICU stay than Bcc-negative patients (12.40 ± 3.20 vs 8.60 ± 2.75 days; p=0.031). Conclusion: Burkholderia cepacia complex represented a clinically important opportunistic pathogen in ICU patients, particularly among those with comorbidities. Its association with prolonged ICU stay and variable antimicrobial susceptibility highlights the need for early detection, susceptibility-guided therapy, strict infection control measures, and strengthened antimicrobial stewardship in critical care settings.