Cellulitis caused by the Burkholderia cepacia complex associated with contaminated chlorhexidine 2% scrub in five domestic cats

Abstract

Isolates of the Burkholderia cepacia complex (BCC) are known as plant and human pathogens. We describe herein BCC infections as the cause of subcutaneous abscesses and purulent cellulitis in 5 cats. All cats were presented with an open wound, and 4 received standard wound care and empiric antibiotic therapy. Despite treatment, clinical signs worsened in 4 cats. Isolates of the BCC were obtained from all 5 cases. Two cats were submitted for postmortem examination. Subcutaneous abscesses with draining fistulas were observed. Histopathology revealed severe, pyogranulomatous cellulitis with intralesional gram-negative bacilli. Based on susceptibility results, the other 3 cats were administered effective antibiotics and recovered without complications. The BCC was cultured from the 2% chlorhexidine surgical scrub solution used in the clinic, suggesting the source of infection for 4 of 5 cats. Given the ability to grow in antiseptic solutions, the extra steps required to culture from antiseptics, and innate multidrug resistance, the BCC poses a challenge to both detect and treat. Although the BCC causes disease almost exclusively in humans with cystic fibrosis or immunodeficiency, the bacteria should also be a differential for nosocomial infections in veterinary patients.