Comprehensive analysis of Burkholderia species head and neck infections: A systematic review

Objective

To report the first systematic review and meta-analysis of Burkholderia species infections of the head and neck to facilitate understanding of the disease's demographics, mortality rate, comorbidities associated, symptoms, and antibiotic treatments utilized.

Data Sources.

COCHRANE Library, CINAHL, PubMed, and Scopus.

Review Methods.

A systematic review and meta-analysis were performed using PRISMA reporting guidelines. Inclusion criteria included non-surgical patients who were diagnosed with any head and neck Burkholderia infection. Demographics included, patient age and gender. Symptoms, antibiotics given, bacteriology, comorbidities and mortality were analyzed. Meta-analysis of continuous measures (mean), and proportions (%) with a 95 % confidence interval (CI) was conducted. Studies were accessed for bias via the JBI appraisal tool.

Results

There were 740 studies screened with 45 studies (N = 132) being included. In total, 50.1 % were females (95 % CI: 43–57) with a mean patient age of 28.7 years (95 % CI: 25.9 to 31.5). Overall survival rate was 83.4 % (95 % CI: 77.5 to 88.4) and predominant localized symptoms were neck swelling at 38.4 % (95 % CI: 27.5 to 49.9), followed by neck abscess at 34.1 % (27.5 to 41.2) and head and neck suppurative lymphadenitis at 22.9 % (17.3 to 29.4). Main antibiotic treatments included: trimethoprim-sulfamethoxazole at 63.0 % (95 % CI: 55.9 to 69.8), ceftazidime at 47.9 % (40.7 to 55.1), and doxycycline at 26.7 % (10.7 to 33.5).

Conclusion

Burkholderia infections exhibit diverse symptoms, which pose a challenge in diagnosis. Additionally, prescription of non-guideline antibiotics highlights the initial difficulty in identifying these organisms as the primary culprit of infection causing delayed treatment.