In the 6 months preceding this patient's presentation, only one other isolate of B cepacia was cultured at our hospital. This isolate was resistant to ofloxacin, cefotaxime, and piperacillin. On the basis of the scarcity of cultures and the marked differences in antibiotic sensitivities between the two isolates, we are confident that the positive result of the culture was not due to laboratory contamination. The absence of any other microbiological diagnosis despite extensive testing also supports the identity of the pathogen as B cepacia.
There is no evidence of cystic fibrosis or any other chronic lung disease in our patient. He had no known exposure to any source of B cepacia, and the fact that the strain was unusually sensitive to drugs is evidence against him having acquired it from someone with chronic lung disease. B cepacia was first identified in agricultural produce, so, inasmuch as one of the patient’s job responsibilities is food preparation, he may have acquired it at work. Concern has been raised about the potential use of B cepacia as a biopesticide in the agricultural industry, but we have been unable to confirm whether it is being used in our region. asthma medications inhalers
In conclusion, we have reported a case of bacteremic CAP due to B cepacia in an immunocompetent host who has no underlying lung disease. Unlike most cases involving B cepacia, the most likely source of this infection is from a nonhospital environment, probably from agricultural produce.