MICROBIOLOGY

• Multi-species complex of bacteria, B. cepacia complex (Bcc) with species: B. cepacia, B. cenocepacia, B. multivorans, B. stablis, B. vietnamiensis, B. dolosa, B. ambifaria, B. lata, B. pyrrocinia.
  • Known to produce secondary metabolites with antifungal and antimicrobial properties.[10]
    • Biosynthesis of antibiotics is controlled by quorum sensing, a global regulatory system that coordinates bacteria behavior, allows cell-to-cell communication, and alters gene expression according to population density.[10][15]
• Non-fermenting, aerobic Gram-negative rod [Fig 1]. Originally described by Burkholder as a causative agent of bacterial rot of onion bulbs (Latin, cepacia = onion).[11]
  • Formerly known as Pseudomonas cepacia.
• Waterborne, nosocomial, opportunistic pathogen. Ubiquitous in water, soil, plants.
• Recognized as the etiologic agent of "foot rot" or "swamp rot," maceration and hyperkeratosis affecting the toe webs of American soldiers who trained in wet terrain.[6]
  
  • Adheres to epithelial cells and mucin; survives inside epithelial cells and macrophages; forms biofilms; secretes catalases, proteases and siderophores.[1]
  • B. cenocepacia associated with the highest risk of mortality.[12]
  • Inherently resistant to many antibiotics, including first and second-generation cephalosporins, carboxypenicillins, aminoglycosides and polymyxins.[6] Multi-drug resistance is common.[16][8]