Achromobacter Xylosoxidans Bloodstream Infection in Elderly Patient with Hepatocellular Carcinoma: Case Report and Review of Literature

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Abstract

Achromobacter xylosoxidansis a nonfermentative Gram-negative organism, known to cause opportunistic infection in humans. We report a case of septicemia in a 76-year-old male patient with underlying hepatocellular carcinoma due to A. xylosoxidans, which showed a different antimicrobial susceptibility pattern from what is usually reported. From aerobic blood culture of the patient, A. xylosoxidans was isolated which was found to be sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefoperazone-sulbactam, meropenem, minocycline, tigecycline, and trimethoprim/sulfamethoxazole. The patient recovered with amoxicillin-clavulanic acid treatment, which was given empirically to the patient. The present case highlights the possible role of amoxicillin-clavulanic acid for treatment of bloodstream infection with A. xylosoxidans.

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Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer (1989-2003).

Gabriel Aisenberg, Kenneth V I Rolston, Amar Safdar (2004)

Achromobacter and Alcaligenes are emerging infectious gram-negative bacterial species that can affect immunosuppressed patients. The authors sought to determine the incidence and characteristics of bloodstream infections caused by these organisms in patients with underlying malignancies. All consecutive episodes of hematogenous Achromobacter and Alcaligenes infections recorded from December 26, 1989, to July 27, 2003, were studied retrospectively. Fifty-two episodes occurred in 46 patients; 31 patients (67%) had hematologic malignancies, and 24 (52%) experienced neutropenia ( 16), and use of mechanical ventilation and pressor support were significantly higher in patients who died (P < 0.001). Logistic regression analysis revealed that sepsis syndrome and high APACHE II scores were predictors of increased 30-day mortality. Most infections caused by this group of nonfermentative gram-negative bacteria were attributable to Ach. xylosoxidans, and only one-third were acquired during hospitalization. The presence of sepsis syndrome has evolved as an independent predictor of poor outcome in patients with high-risk malignancies accompanied by Achromobacter bloodstream infections.

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Achromobacter xylosoxidans bacteremia: report of four cases and review of the literature.

Alexander Bradley, C Chenoweth, Roger S. Goldstein … (1996)

Seventy-seven cases of bacteremia due to Achromobacter xylosoxidans were reviewed, and susceptibility studies were performed on 11 clinical isolates of A. xylosoxidans. Nosocomial bacteremia was noted in 54 of 77 patients (70%), and 28 (36%) had infection associated with an outbreak or acquired from a discrete point source. The most common underlying illnesses were malignancies (30%) and cardiac disease (21%); immunosuppression affected 27%. The most common clinical syndromes were primary and catheter-associated bacteremia (19% each) and pneumonia (16%). The case-fatality rate was 30%; only 3% of patients with primary or catheter-associated bacteremia died, but 65% of patients with meningitis, endocarditis, and pneumonia died. The case-fatality rate in neonates was 80%. Susceptibility studies showed that all strains were resistant to aminoglycosides, most were resistant to quinolones, and all were susceptible to broad-spectrum penicillins, imipenem, ceftazidime, and trimethoprim-sulfamethoxazole. Two-disk approximation and time-kill studies showed synergy or additive effects for the combination of gentamicin and piperacillin against most strains.

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Achromobacter xylosoxidans bacteremia: a 10-year analysis of 54 cases.

J Gómez-Cerezo, I. Suarez, J J Ríos … (2003)

Fifty-four cases of Achromobacter xylosoxidans bacteremia diagnosed over a 10-year period in patients from 2 months to 87 years of age were reviewed. Fifty-two episodes were nosocomial. The most frequent underlying condition was neoplasm (solid or hematological). The source of infection was a contaminated intravenous catheter in 35 patients (60%) and pneumonia in 6 patients. Eight (15%) patients died. The only risk factors significantly associated with mortality were age over 65 years and neutropenia. The results of in vitro susceptibility studies of the isolates showed that antibiotic therapy with antipseudomonal penicillins or carbapenems would be a reasonable choice. An epidemiological study conducted in the hemodialysis unit showed Achromobacter xylosoxidans in tap water and on the hands of two healthcare workers but not in the hemodialysis systems. Patients were probably contaminated when healthcare workers manipulated the intravenous catheters without wearing gloves.

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Author and article information

Journal

Journal ID (nlm-ta): J Lab Physicians

Journal ID (iso-abbrev): J Lab Physicians

Journal ID (publisher-id): JLP

Title: Journal of Laboratory Physicians

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0974-2727

ISSN (Electronic): 0974-7826

Publication date (Print): Jul-Dec 2015

Volume: 7

Issue: 2

Pages: 124-127

Affiliations

[1]Department of Laboratory Medicine, Delhi State Cancer Institute, New Delhi, India

[1 ]Department of Clinical Oncology, Delhi State Cancer Institute, New Delhi, India

Author notes

Address for correspondence: Dr. Nishat Hussain Ahmed, E-mail: drnishathussain@ 123456rediffmail.com

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Publisher ID: JLP-7-124

DOI: 10.4103/0974-2727.163133

PMC ID: 4559626

PubMed ID: 26417165

SO-VID: 6c826728-be22-424a-af40-0605933c7266

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Achromobacter Xylosoxidans Bloodstream Infection in Elderly Patient with Hepatocellular Carcinoma: Case Report and Review of Literature

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Journal of Circulating Biomarkers

Most cited references 15

Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer (1989-2003).

Achromobacter xylosoxidans bacteremia: report of four cases and review of the literature.

Achromobacter xylosoxidans bacteremia: a 10-year analysis of 54 cases.

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