Successful salvage therapy with tigecycline and trimethoprim/sulfamethoxazole for recurrent osteomyelitis caused by Burkholderia cepacia

Successful salvage therapy with tigecycline and trimethoprim/sulfamethoxazole for recurrent osteomyelitis caused by Burkholderia cepacia Dear Editor,With great interest, we read the article by Kuo et al 1 in the Journal of Microbiology, Immunology and Infection, which reports that Burkholderia cepacia is an important pathogen in elderly patients, and the success rate of tigecycline therapy for osteomyelitis is only 50%.Here, we report a case of recurrent osteomyelitis and bacteremia caused by B. cepacia.The patient received salvage therapy with tigecycline and trimethoprim/sulfamethoxazole successfully during the second treatment course.An 80-year-old female patient suffered from falling down and traumatic injury of chest wall sternal bone.Fever, chills, and pus discharge from the sternal bone were noted 6 days later.The blood and pus culture work-ups were performed at admission, and both grew B. cepacia.The susceptibility testing of B. cepacia showed that it was sensitive to ceftazidime, meropenem, trimethoprim/sulfamethoxazole, and tigecycline; intermittent to moxifloxacin; and resistant to amikacin and ciprofloxacin.The patient was initially treated with ceftazidime 2 g intravenously q8h for 14 days.Then she received oral trimethoprim/sulfamethoxazole 160/800 mg twice daily and oral moxifloxacin 400 mg every day at the outpatient clinic for 3 months.Her clinical condition improved, and the laboratory data of C-reactive protein and erythrocyte sediment rate revealed a normal range.However, unfortunately, she suffered from fever, sternal bone pain, and pus discharge 1 month after discontinuing the oral antibiotic therapy.She was readmitted to a ward, and received tigecycline 50 mg intravenously q12h and 100 mg stat, plus trimethoprim/sulfamethoxazole 160/800 mg intravenously twice daily as salvage therapy for 1 month.A gallium scan of the whole body showed negative finding, and C-reactive protein and erythrocyte sediment rate at the outpatient clinic were also within the normal range 3 months after discontinuing the antibiotic therapy.B. cepacia (formerly Pseudomonas cepacia) is increasingly recognized as an important pathogen in elderly and critically ill patients.1,2 It is an aerobic, Gram-negative,