Violet-pigmented Burkholderia contaminans sequence type 922 bacteremia in an end-stage renal disease patient - a case report and review of the literature.

Abstract

Burkholderia cepacia complex (Bcc) is an emerging nosocomial pathogen, with violet-pigmented strains representing a rare and possibly neglected but clinically important subset. We report a case of a 62-year-old man with end-stage renal disease on dialysis who presented with fever and cough. Blood cultures from central and peripheral lines grew violet-pigmented, non-lactose fermenting colonies on MacConkey agar, later identified as Burkholderia contaminans sequence type 922 (ST922) via a multimodal approach. Initial phenotypic methods (VITEK-2, API20NE and MALDI-ToF) and 16S rDNA sequencing were inconclusive; however, multilocus sequence typing confirmed ST922, a strain previously reported in India and associated with nosocomial outbreaks. The isolate was susceptible to ceftazidime, trimethoprim/sulfamethoxazole, minocycline, and meropenem. The patient responded well to intravenous ceftazidime, with subsequent blood cultures yielding no growth. Notably, antimicrobial susceptibility varied geographically, with some ST922 isolates resistant to third-generation cephalosporins. This case illustrates the diagnostic challenges in Bcc speciation and highlights the value of molecular tools such as MLST. The detection of this strain in Malaysia raises concerns about global dissemination, potentially via contaminated medical devices or water systems. Early recognition of violet-pigmented Bcc in resource-limited settings can facilitate prompt, targeted treatment. This report underscores the need for environmental surveillance and antimicrobial stewardship to prevent spread, while reinforcing Bcc's ecological adaptability and clinical significance, especially in immunocompromised individuals.