A rare case of urinary tract infection by Burkholderia cepacia

Burkholderia cepacia is a motile, aerobic, non-fermentative, gram-negative bacillus and has been widely documented as a lung pathogen in patients with cystic fibrosis and chronic granulomatous disease. It is documented as an important emerging cause of multi-drug resistant nosocomial infections, and an important cause of morbidity and mortality. A 64-year-old male patient visited the Nikea Primary Healthcare Center, Piraeus, Greece, referred by the family doctor (GP), for follow-up due a history of prostate cancer (patient on immunosuppression) and recurrent UTIs with subsequent admission to the hospital. Patient history revealed diabetes mellitus type 2, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, history of recurrent UTIs, with 4 hospitalizations in a tertiary hospital during the last 2 years, prostatic hypertrophy, 2 episodes of prostatitis before the diagnosis of prostate cancer Gleason score 6, at the end of 2019, with subsequent total prostatectomy, and radiotherapy. Patient history also revealed dysuria, frequent urination, pain and burning sensation during urination and erectile dysfunction. Urinalysis showed intense pyuria, abundance of micro-organisms and abundance of red blood cells. The urine culture grew monomicrobial Burkholderia cepacia > 10⁵ CFU/ml. The bacterium was identified by the RapID™ REMEL ONE identification system (Thermo Fisher Scientific). Antimicrobial susceptibility testing revealed susceptibility to antibiotics such as, Ceftazidime, Ciprofloxacin, Norfloxacin, Levofloxacin and Imipenem.The patient received treatment with Levofloxacin. Burkholderia cepacia infections outside the respiratory system are rare. Moreover, recurrent UTIs with B. cepacia is a rare finding, which highlights the importance of our study. UTIs with B. cepacia have been associated with bladder irrigation or use of contaminated hospital objects and liquids. B. cepacia is one of the most antimicrobial-resistant organisms and treatment options are limited. The patient was treated with Levofloxacin (3rd generation fluoroquinolone — Tavanic) 500 mg daily per os for 2 weeks, due to his history.