Atypical Burkholderia Cepacia Resistance to Ceftazidime/Avibactam and Co-trimoxazole: A Case of Open Wound Contamination and Persistent Bacteremia

Wound contamination and subsequent colonization by microbes can significantly impair tissue repair and lead to the development of chronic non-healing ulcers. Atypical Burkholderiaand Actinomycetesbacterial species are common in cases of soil contamination of open wounds leading to a complex infection that is both difficult to diagnose and treat. Despite much research on the involvement of atypical organisms, including Burkholderiaand Actinomycetes, in antibiotic resistance, there is no consensus on the timeline from contamination to infection and on an algorithm for early diagnosis and management. Thus, the ways in which these organisms interact in settings of co-infection and contribute to cross-resistance remains unclear. The generally low index of clinical suspicion for atypical microbial infections and the absence of clear diagnostic protocols have multiple consequences, ranging from excessive reliance on pathology, delayed treatment, expensive and ineffective investigations and treatment, and progressive wound sepsis and morbidity. We are reporting a case of Burkholderia cepacia infection, co-infection with Actinomyces spp., and resistance to ceftazidime/avibactam and co-trimoxazole in a 28-year-old previously healthy farmer following soil contamination of an open wound. This is one of only a few reported cases of Burkholderia resistance to ceftazidime/avibactam and the first reported case ofB.cepacia bacteremia due to peripheral contamination.