Cepacia syndrome in cystic fibrosis: A systematic review of the literature and possible new perspectives in treatment

BackgroundCepacia syndrome (CS) is an acute, necrotizing pneumonia with a high mortality rate, occurring in patients with cystic fibrosis (CF) infected with Burkholderia cepacia complex (BCC). Due to its low incidence, data on this condition are limited. MethodsWe conducted a systematic review of the reported cases of CS by searching MEDLINE, Embase and the Cochrane Library to improve knowledge of this rare but potentially lethal condition. ResultsWe included 15 eligible articles, describing 18 cases (9 females) of CS. Median age at onset was 22 years (range: 10-60 years); median time to CS after first infection by BCC was 5 years (range: 1-26 years). Burkholderia cenocepacia was the most frequently reported causative agent. All patients received intravenous antibiotic treatment (most frequently including cotrimoxazole), while inhaled antibiotics were used in five patients (27.8%). Immunosuppressant agents were the most commonly prescribed supportive treatment (n = 7, 38.9%). Half of the patients died (9/18, 50%). ConclusionsThis study describes epidemiological, clinical characteristics, and prognosis of CS cases reported over the last 24 years. CS is a rare yet severe complication of BCC infection in patients with CF, which occurs several years after BCC colonization and has a negative outcome in 50% of the patients. Data are too scanty to identify the most effective therapeutic approach.

Automated summary

This study provides insights into Cepacia syndrome (CS), a rare but potentially lethal complication of Burkholderia cepacia complex (BCC) infection in cystic fibrosis (CF) patients. The study includes a systematic review of 18 cases of CS reported over the last 24 years, with a high mortality rate of 50%. The data are insufficient to determine the most effective therapeutic approach for CS.