violet and bile salts to inhibit the growth of Gram-positive cocci, and ticarcillin and polymyxin B to inhibit the growth of other Gram-negative bacilli. It also contains phenol red pH indicator which turns pink when it reacts with alkaline byproducts generated by the bacteria when it grows. Alternatively, oxidation-fermentation polymyxin-bacitracin-lactose (OFPBL) agar can be used. OFPBL contains polymyxin (which kills most Gram-negative bacteria, including Pseudomonas aeruginosa) and bacitracin (which kills most Gram-positive bacteria and Neisseria species). It also contains lactose, and organisms such as BCC that do not ferment lactose turn the pH indicator yellow, which helps to distinguish it from other organisms that may grow on OFPBL agar, such as Candida species, Pseudomonas fluorescens, and Stenotrophomonas species. Treatment Treatment typically includes multiple antibiotics and may include ceftazidime, minocycline, piperacillin, meropenem, chloramphenicol, and trimethoprim/sulfamethoxazole(co-trimoxazole). Although co-trimoxazole has been generally considered the drug of choice for B. cepacia infections, ceftazidime, minocycline, piperacillin, and meropenem are considered to be viable alternative options in cases where co-trimoxazole cannot be administered because of hypersensitivity reactions, intolerance, or resistance. Newer beta-lactam / beta-lactamase combinations like ceftazidime-avibactam or ceftolozane-tazobactam can also be effective. Burkholderia cepacia is intrinsically resistant to colistin and usually resistant to aminoglycosides. In people with cystic fibrosis, evidence is insufficient about the effectiveness of long-term antibiotic treatment with continuous inhaled aztreonam lysine (AZLI) in terms of lung function or chest infections. History B. cepacia was discovered by Walter Burkholder in 1949 as the cause of onion skin rot, and first described as a human pathogen in the 1950s. It was first isolated in patients with cystic fibrosis (CF) in 1977, when it was known as Pseudomonas cepacia. In the 1980s, outbreaks of B. cepacia in individuals with CF were associated with a 35% death rate. B. cepacia has a large genome, containing twice the amount of genetic material as E. coli. See also Contamination control Povidone-iodine (contamination by BCC) References Further reading External links Burkholderia cepacia complex in the NCBI Taxonomy Browser Type strain of Burkholderia cepacia complex at BacDive, the Bacterial Diversity Metadatabase Type strain of Burkholderia cepacia at BacDive, the Bacterial Diversity Metadatabase Bacterial diseases Burkholderiaceae Healthcare-associated infections