Multidrug Resistance and Clinical Predictors of Mortality in Burkholderia cepacia complex Bacteremia: Local Evidence and Global Perspectives With a Review of the Literature.

Abstract

Background <i>Burkholderia cepacia complex</i> (BCC) is an opportunistic, intrinsically multidrug-resistant (MDR) pathogen increasingly recognized as a cause of bloodstream infection (BSI) in non-cystic fibrosis adults. Data from South Asia remain limited, and predictors of outcomes have not been systematically evaluated using standardized MDR definitions. Materials and methods We conducted a six-year retrospective study (January 2019-December 2024) at a 2,000-bed tertiary care hospital in eastern India. Adults (≥18 years) with culture-confirmed BCC BSI and available antimicrobial susceptibility data were included. Antimicrobial susceptibility testing was performed using VITEK® 2 (bioMérieux, France) and interpreted according to Clinical and Laboratory Standards Institute (CLSI) M100 (33rd edition). MDR was defined as resistance to three or more of six antibiotic classes. Independent predictors of in-hospital mortality were assessed using multivariable logistic regression. The primary objective was to identify independent clinical predictors of in-hospital mortality in adults with BCC BSI. A secondary objective was to describe antimicrobial resistance patterns and contextualize findings through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review (2004-2024). Results Among 124 patients (median age 48 years; 52.4% male), 64.5% of isolates were MDR. Overall in-hospital mortality was 33.9%. Carbapenem resistance was high (imipenem 61.3%, meropenem 56.5%), while minocycline (85.5% susceptible), trimethoprim-sulfamethoxazole (TMP-SMX) (52.4%), and levofloxacin (80.6%) retained the most significant activity. In multivariable analysis, a higher qSOFA score (adjusted OR 2.26, p = 0.016), ICU admission (OR 3.37, p = 0.023), and multiorgan dysfunction syndrome (OR 3.05, p = 0.050) independently predicted mortality; the MDR phenotype was not significant. The systematic review identified 14 studies (n = 1,541) with mortality ranging from 21% to 64%, with most cohorts clustering around 30-50%. High carbapenem resistance and preserved susceptibility to TMP-SMX and minocycline were consistent global findings. Conclusions Across local and global data, severity of illness rather than MDR phenotype was the strongest predictor of mortality in BCC bacteremia. Widespread resistance to β-lactams and carbapenems limits empiric options, whereas minocycline, TMP-SMX, and levofloxacin remain the most reliable agents. Rapid species-level diagnostics, timely susceptibility testing, and targeted antimicrobial stewardship are essential to improve clinical outcomes and infection control in high-risk hospital settings.