Combination antimicrobial susceptibility testing of Burkholderia cepacia complex: significance of species

Felicity K Abbott, Kathleen E N Milne, David A Stead, Ian M Gould

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11 Citations (Scopus)


The Burkholderia cepacia complex (Bcc) is notorious for the life-threatening pulmonary infections it causes in patients with cystic fibrosis. The multidrug-resistant nature of Bcc and differing infective Bcc species make the design of appropriate treatment regimens challenging. Previous synergy studies have failed to take account of the species of Bcc isolates. Etest methodology was used to facilitate minimum inhibitory concentration (MIC) and antimicrobial combination testing on 258 isolates of Bcc, identified to species level by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). The most active antimicrobials were trimethoprim/sulphamethoxazole, doxycycline and minocycline (52.5%, 46.4% and 45.9% of isolates susceptible, respectively). Synergy was observed in 9.2% of the 1799 combinations tested; the most common synergistic combinations were tobramycin + ceftazidime, meropenem + tobramycin and levofloxacin + piperacillin/tazobactam (35.4%, 32.3% and 22.2% synergy, respectively). Antimicrobial susceptibility analysis revealed differences between Burkholderia cenocepacia and Burkholderia multivorans. Disparity in clinical outcome during infection with these two micro-organisms necessitates further investigation into the clinical outcomes of treatment regimens in light of species identification and in vitro antimicrobial susceptibility studies.

Original languageEnglish
Pages (from-to)521-527
Number of pages7
JournalInternational Journal of Antimicrobial Agents
Issue number5
Early online date12 Sept 2016
Publication statusPublished - Nov 2016

Bibliographical note

Funding: CFASS is funded by the National Services Division of the Common Services Agency of the Scottish Executive and is available for use by Scottish Adult CF centres. The MALDI-TOF/MS analysis was supported by a grant from the NHS Grampian Clinical Microbiology Fund (NHS Grampian Endowment Funds Registered Charity Number SC017296).

The authors thank the laboratories and clinicians who use the Cystic Fibrosis Antibiotic Susceptibility testing Service (CFASS) for their support.


  • Burkholderia cepacia complex
  • B. cenocepacia
  • B. multivorans
  • antimicrobial susceptibility testing
  • synergy testing
  • Etest


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