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.[16]
    • The 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.[16][21]
• 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).[17]
  • Formerly known as Pseudomonas cepacia.
• A waterborne, nosocomial, opportunistic pathogen is ubiquitous in water, soil, and 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.[11]
  
  • Adheres to epithelial cells and mucin; survives inside epithelial cells and macrophages; forms biofilms; and secretes catalases, proteases and siderophores.[1]
  • B. cenocepacia is associated with the highest risk of mortality.[18]
    • B. cenocepacia ET-12 strain is associated with nosocomial transmission.[7]
• Inherently resistant to many antibiotics, including first- and second-generation cephalosporins, carboxypenicillins, aminoglycosides and polymyxins.[11] Multi-drug resistance is common.[22][14]