Burkholderia cepacia complex infections beyond hospital outbreaks: A 22-Year analysis of clinical characteristics, antimicrobial resistance, and mortality predictors

Background: Burkholderia cepacia complex bacteria are intrinsically multidrug-resistant opportunistic pathogens that pose a growing threat in hospital settings, particularly among immunocompromised patients. Despite its clinical significance, data on sporadic Burkholderia cepacia complex infections outside cystic fibrosis populations and hospital outbreaks remain limited. Methods: A 22-year retrospective observational cohort study (May 2001–April 2023) was carried out at a tertiary care academic center in the Eastern Province of Saudi Arabia. Adults hospitalized with confirmed Burkholderia cepacia infection and ≥ 72 h of antibiotic therapy were included. Demographics, comorbidities, infection type, microbiological resistance profiles, treatment outcomes, and mortality predictors were analyzed using logistic regression and Kaplan-Meier survival estimates. Results: Of 189 identified cases, 151 patients met the inclusion criteria (mean age 53 ± 21 years; 57.6 % male). The majority of infections were hospital-acquired (84.8 %), with bloodstream infections (33.1 %) and ventilator-associated pneumonia (26.5 %) being the most prevalent. Resistance was high to piperacillin/tazobactam (73.6 %), ceftazidime (58.6 %), levofloxacin (57.4 %), carbapenems (42.0 %), and trimethoprim-sulfamethoxazole (30.3 %). Clinical resolution was achieved in 82.1 %, but bacteriological eradication occurred in only 56.9 %, with a recurrence rate of 17.2 %. Mortality reached 9.9 % at 14 days, 17.2 % at 30 days, and 35.8 % at one year. Independent predictors of 30-day mortality included advanced age, critical care admission, central venous catheter insertion, mechanical ventilation, and resistance to fluoroquinolones or carbapenems. Conclusions: Our findings indicate that Burkholderia cepacia complex infections represent a significant clinical challenge due to antibiotic resistance and elevated mortality rates. The data highlight the importance of improving diagnostic and treatment approaches, as well as implementing effective infection control policies, especially for vulnerable hospitalized populations.