Chronic Urinary Tract Infection Due to Burkholderia cenocepacia in an Immunocompetent Adult Without Risk Factors: A Rare Case Report

Abstract

Background: Burkholderia cenocepacia, a multidrug-resistant member of the Burkholderia cepacia complex, is an opportunistic pathogen rarely implicated in urinary tract infections (UTIs). Reported cases almost exclusively involve immunocompromised or catheterized patients. Its isolation from the urinary tract of an immunocompetent host without predisposing factors is exceptionally uncommon. Objective: To describe a culture-confirmed chronic UTI caused by B. cenocepacia in a healthy adult, emphasizing diagnostic accuracy, antimicrobial resistance, and treatment outcome. Methods: A 32-year-old male with six-month lower urinary tract symptoms underwent urinalysis, culture, and imaging. Organism identification was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and repeat culture after 14 days. Antimicrobial susceptibility was determined by Kirby–Bauer disc diffusion interpreted per Clinical and Laboratory Standards Institute 2024 criteria. Results: Urine culture repeatedly yielded B. cenocepacia >10⁵ CFU/mL, resistant to aminoglycosides, fluoroquinolones, and β-lactams but susceptible to trimethoprim–sulfamethoxazole (TMP–SMX) and meropenem. Initial 14-day TMP–SMX therapy led to transient improvement followed by relapse; a subsequent six-week course achieved complete clinical and microbiological resolution. Follow-up cultures at one and three months were sterile. Conclusion: B. cenocepacia can cause chronic, community-acquired UTI in immunocompetent adults. Accurate identification using MALDI-TOF MS and prolonged, susceptibility-guided TMP–SMX therapy are essential for eradication and prevention of recurrence