(1464) First Reported Case of Paraburkholderia Species Sepsis in a Human

Introduction: Paraburkholderia is a gram-negative rod that is not generally considered to be a primary human pathogen, instead; it is an environmental habitat of the plants and soil. Infections in humans haven’t been reported yet as this organism was established in 2016. Herein, we present the first case in the literature of a 51-year-old female patient with Paraburkholderia sp. sepsis.

Description: A 51-year-old female with PMH of gastrectomy and who is TPN dependent via Port-A-Cath presents to the emergency department with recurrent episodes of fever and chills. The patient denied any nasal stuffing, cough, abdominal pain, or diarrhea. On examination, she was febrile (102.9 degrees F), tachycardic, and tachypnoeic, and her blood pressure was 109/55 (MAP 73). Labs were positive for elevated lactic acid at 3.7 mmol/l, and Procalcitonin at 1.89 ng/mL. She was started on sepsis fluids at 30 ml/kg, cultures were obtained, and IV broad-spectrum antibiotics with Cefepime and Vancomycin were started. The patient was admitted for severe sepsis without septic shock likely due to Port-A-Cath associated bloodstream infection. Initial blood cultures grew gram-negative rod organisms which were unable to be identified on the VITEK2 instrument and infectious diseases service was consulted. Mass Spectrometry identified the organism as Paraburkholderia Sp with a positive sensitivity for Meropenem, for which all antibiotics were stopped and Meropenem was started. TTE was negative for any vegetation as part of her cardiology evaluation. The Port-A-Cath was removed by vascular surgery and a new PICC line was inserted for TPN and Antibiotics. Her symptoms continued to improve and she was discharged on Meropenem for a total course of 2 weeks.

Discussion: The Paraburkholderia Genus was previously included in the genus Burkholderia and not known about their manifestations in humans. Risk Factors include chronic immunosuppression, catheters, ports, exposure to contaminated water or soil, Invasive medical procedures, and previous antibiotic use. These organisms can often exhibit resistance to multiple antibiotics, making selection of appropriate treatment a complicated task. Some Paraburkholderia sp. have shown susceptibility to TMP-SMX, carbapenems, fluoroquinolones, aminoglycosides, and Colistin.