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Your patient has an infection with a very resistant bacteria, which is rare but when present is usually acquired through a catheterized bladder. There are 2 issues here.
First of all Burkholderia cepacia is very a very unusual isolate to have, if the patient does not have Cystic Fibrosis. In addition, it difficult it identify correctly. Ralstonia and other closely related mircoorganisms are often confused with it. The isolate should be sent to a reference laboratory to have the identification confirmed for several reasons. If the patient has Cystic Fibrosis (CF), the isolation of this organism marks the patient as contagious for other CF patients and no longer a candidate for transplantation. To label the patient as unable to interact with other CF patients can be socially devastating. Also the rarity of the isolate for other patients suggests that nosocomial transmission has occurred and an Infection Control investigation should be started to determine the cause of the infection.
The second issue is antimicrobial testing. This organism is very slow-growing and cannot be tested for piperacillin/tazobactam using either the Kirby Bauer method or the Vitek and probably the Phoenix system. The disk method has proved to be reliable only for ceftazidime, minocycline, meropenem, and sulfa trimethoprim. The Vitek is too rapid a system to reliably test slow-growing bacteria. Thus the isolate should be sent to a reference lab for testing, unless you have a method of testing that is an overnight MIC method (e.g. etest, Microscan or manual MIC microtiter).
If the identification and the MIC are certain, and the patient was treated appropriately with piperacillin/tazobactam, then the only explanation for the lack of response is that the bug has now become resistant or that the patient has an underlying condition that does not allow clearance of the bacteria. The physicians will have to consider some testing and possibly surgical intervention to determine why the patient is not responding to the antibiotic.
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