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      Case report: The first case of Achromobacter xylosoxidans-related tunnel infection in a patient receiving peritoneal dialysis

      case-report
      , MD a , , MD, PhD b , c , d ,
      Medicine
      Wolters Kluwer Health
      Achromobacter xylosoxidans, peritoneal dialysis, tunnel infection

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          Abstract

          Rationale:

          Achromobacter xylosoxidans infection is mostly reported in immunocompromised patients. Until now, it is still rarely reported in patients undergoing peritoneal dialysis.

          Patient concerns:

          This is the 1st case of A xylosoxidans infection due to tunnel infection of a Tenckhoff catheter.

          Diagnosis:

          The diagnosis was confirmed by the report of culture.

          Interventions:

          Risk factors for this infection in peritoneal dialysis include uremia with an immunocompromised state, contamination due to inexperienced skills, and aqueous environment of the dialysate.

          Outcome:

          We believe that finding the source of A xylosoxidans contamination is the most important aspect of the overall treatment of the infection.

          Lessons:

          Environmental investigation of suspected source contamination is warranted in those with A xylosoxidans infection. Once the diagnosis is made, removal of the Tenckhoff catheter should not be delayed.

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          Most cited references11

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          Nosocomial colonization and infection by Achromobacter xylosoxidans.

          Achromobacter xylosoxidans, a bacterial species named in 1971, is often isolated from aqueous environments, but little has been reported about its pathogenicity in humans, its epidemiological pattern, and its susceptibility to antibiotics and antiseptics. We were faced with an epidemic caused by this microorganism for 18 months in an intensive care unit. Two patients had fatal infections and 37 others were colonized. The source was the deionized water of the hemodialysis system. The 46 isolates were identified by comparison with the reference strain A. xylosoxidans ATCC 27061. The characteristic cellular fatty acids of this species were demonstrated by gas-liquid chromatography. The minimal inhibitory concentrations of 27 antibiotics were determined. The isolates were susceptible to only two: moxalactam at 4 micrograms/ml and ceftazidime at 8 micrograms/ml. The minimal bactericidal concentrations of one disinfectant and three antiseptics were: sodium hypochloride, 109 micrograms/ml; chlorhexidine digluconate in ethanol solution, 15 to 125 micrograms/ml; polyvinylpyrrolidone iodine, 750 micrograms/ml; and iodine ethanol, 312 to 625 micrograms/ml.
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            Clinical and laboratory characteristics of Achromobacter xylosoxidans infection.

            Achromobacter xylosoxidans was isolated from six patients. The organism causes opportunistic infections in patients who are compromised. A. xylosoxidans is a catalase- and oxidase-positive, motile, gram-negative rod that oxidizes xylose and glucose. The organism exists in a water environment and may be confused with Pseudomonas species. Unlike pseudomonas, achromobacter has peritrichous flagella. The clinical and laboratory characteristics of A. xylosoxidans are presented.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Continuous ambulatory peritoneal dialysis-related exit-site infections caused by Achromobacter denitrificans and A. xylosoxidans.

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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                April 2017
                21 April 2017
                : 96
                : 16
                : e6654
                Affiliations
                [a ]Department of Family Medicine, Cheng Ching General Hospital
                [b ]Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital
                [c ]Department of Life Science, Tunghai University, Taichung
                [d ]Department of Medicine, Nation Yang Ming University, Taipei, Taiwan.
                Author notes
                []Correspondence: Shang-Feng Tsai, Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan (e-mail: s881056@ 123456gmail.com ).
                Article
                MD-D-16-07364 06654
                10.1097/MD.0000000000006654
                5406086
                28422870
                5626a592-91a9-4733-b6e7-06a1a2be1248
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0

                History
                : 7 December 2016
                : 20 March 2017
                : 27 March 2017
                Categories
                5200
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                achromobacter xylosoxidans,peritoneal dialysis,tunnel infection

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