Burkholderia cepacia is a Gram-negative bacterium that is a common pathogenic microorganism widely found in the natural environment, including soil, water bodies, plant roots, etc. It has strong adaptability and tolerance, able to survive and reproduce in different habitats. Although most Burkholderia cepacia strains are harmless to humans, certain strains may cause infections in individuals with weakened immune systems or chronic diseases such as cystic fibrosis. These infections are typically associated with transmission from healthcare workers, shared respiratory therapy equipment among patients, contact with Burkholderia cepacia-contaminated items, and implants in the body [3, 4, 5].
The patient has a history of hepatitis B virus carriage and was admitted to the hospital due to severe intracranial hypertension, cerebral hernia, and subsequent cardiac arrest caused by subarachnoid hemorrhage, with immunocompromise present. Upon admission, the patient's circulation was unstable, and vasoactive pressor agents were difficult to discontinue, sometimes requiring higher doses and combined use of multiple vasoconstrictor drugs. Coupled with severe intracranial hypertension, this led to poor blood supply and poor healing at the local incision of the ventricle's omyaya, providing a pathway for infection and subsequent invasion of pathogens into the body, triggering sepsis and multiple organ failure. Although the patient's sputum culture, blood culture, and cerebrospinal fluid NGS test results all showed Burkholderia cepacia infection, and meropenem was administered according to intracranial infection dosage based on drug sensitivity for anti-infection treatment, the infection could still not be effectively controlled.At this time, it is considered that the patient's severe intracranial hypertension makes it difficult for intravenously administered drugs to effectively reach the brain tissue, necessitating an increase in drug concentration. Additionally, the undetected and untreated secondary infection caused by the omyaya foreign body implant is also a significant factor contributing to the ineffective control of the infection. Although the omyaya device was removed and VSD drainage was provided through multidisciplinary team collaboration, the infection persisted. We need to be highly vigilant about the possible influence of multiple drug resistance mechanisms of Burkholderia cepacia. Burkholderia cepacia exhibits extensive antibiotic resistance through various mechanisms such as aminoglycoside-modifying enzymes, β-lactamases, sulfonamide resistance, quinolone resistance, drug efflux pumps, transferable resistance genes, biofilm formation, and resistance genes contained in the common regions of integrons and insertion sequences [6, 7]. According to research, Burkholderia cepacia has a resistance rate of over 90% to gentamicin, ampicillin, nitrofurantoin, ceftriaxone, cefotetan, imipenem, and colistin, which may be inherent drug resistance characteristics of the pathogen [8].Burkholderia cepacia exhibits high resistance to aminoglycosides and polymyxins, and also has a relatively high resistance rate to chloramphenicol and fosfomycin. However, its resistance rates to meropenem, sulfamethoxazole/trimethoprim, and semi-synthetic penicillins are currently low. Therefore, meropenem is often considered one of the preferred drugs for treating such infections. However, in recent years, studies have shown an increasing concern regarding resistance rates. For instance, one study found that the sensitivity rate of Burkholderia cepacia to meropenem was only 27% [9]. Hence, when the effect of monotherapy is unsatisfactory or in cases of severe infections, combination therapy with different drugs should be considered. Studies have demonstrated that the combination of ceftazidime with ciprofloxacin, rifampin, or tobramycin exhibits significantly better bactericidal activity against lung infections caused by Burkholderia cepacia compared to ceftazidime alone. In particular, the addition of ciprofloxacin significantly enhances the average bactericidal activity of piperacillin, imipenem, and piperacillin. Nevertheless, there are currently no clear guidelines recommending specific drug combinations for the treatment of intracranial infections caused by Burkholderia cepacia, and relevant case reports are rare [10, 11]. Due to the presence of the blood-brain barrier, some drugs have lower concentrations in the central nervous system, such as tobramycin, or may exhibit central side effects, such as quinolones like levofloxacin. Therefore, drug selection is relatively limited when treating complex intracranial infections. Although sulfamethoxazole/trimethoprim is less commonly used in mainland China, it maintains high sensitivity against some pathogens, with studies showing a resistance rate of only 5.1% against Burkholderia cepacia [12].For some non-intracranial infections caused by Burkholderia cepacia, studies have shown that the combination of meropenem and sulfamethoxazole/trimethoprim can achieve certain therapeutic effects [13, 14]. Considering their high brain tissue permeability and low resistance rates, the combination therapy is considered feasible to some extent [15]. Ultimately, with the treatment of multiple drug combinations, the patient successfully controlled the intracranial infection.