Breakpoints #125 – The Scariest and Baddest: Burkholderia, Achromobacter, and Elizabethkingia
Oct 31, 2025
Dr. Ryan Shields, an expert in antibiotic management, Dr. Robert Bonomo, a physician-scientist studying drug resistance, and Dr. Maria Mojica, a microbiologist specializing in resistance mechanisms, discuss frightening gram-negative bacteria like Burkholderia and Elizabethkingia. They delve into the complexities of antibiotic resistance, revealing how these pathogens can impact vulnerable populations. Join them for a chilling exploration of infection risks, treatment challenges, and breakthroughs in combating these resilient bugs.
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Burkholderia Is A Diverse Clinical Puzzle
- Burkholderia cepacia complex contains many genetically distinct but phenotypically similar species that complicate clinical identification and treatment.
- Species-level differences (e.g., cenocepacia vs multivorans) predict virulence, transmissibility, and transplant candidacy.
Multiple Layers Drive Burkholderia Resistance
- Burkholderia resists antibiotics via low outer membrane permeability, powerful efflux pumps, target mutations, and diverse beta-lactamases.
- Inducible pen-family beta-lactamases and variable enzyme types (PEN-A, PEN-B) make predicting susceptibility difficult.
Start With Traditional Agents, Escalate Pragmatically
- Prefer ceftazidime and meropenem as starting beta-lactams when susceptibility appears reasonable for Burkholderia.
- Consider trimethoprim-sulfamethoxazole or minocycline and escalate to ceftazidime-avibactam or cefiderocol if clinical response is poor.