Achromobacter xylosoxidans Bacteremia in a Liver Transplant Patient: A Case Report and Literature Review

Abstract

Since the first isolation of Achromobacter xylosoxidans, it has been increasingly recognized as an opportunistic pathogen. It is an aerobic Gram-negative bacillus mainly found in aquatic environments. It has been reported to cause nosocomial infections, especially in immunocompromised patients. This organism has a unique susceptibility to antimicrobials, being resistant to most commonly used cephalosporins and aminoglycosides, with susceptibility to piperacillin/tazobactam and most carbapenems. In this case, we report a case of a 60-year-old female with a history of liver transplantation, who developed nosocomial Achromobacter xylosoxidans bacteremia complicated by septic shock, multi-organ failure, and death.

Sepsis Due to Achromobacter xylosoxidans in a Tertiary Care Centre: Case Series

“…Barakat M. et al in Doha, QAT (2022) pointed out the resistance to amikacin, cefepime, ciprofloxacin, levofloxacin, and gentamycin; sensitivity to piperacillin-tazobactam, meropenem, and trimethoprim-sulfamethoxazole; and intermediate pattern to ceftazidime in a patient with septicemia complicated by septic shock and multi-organ failure which led to death [ 9 ].…”

“…The first pancreatic pseudocyst report and local wound infection of metastatic ductal carcinoma caused to A. xylosoxidans have been reported by Eshwara et al[1].Another study byOtta S. et al in Bhubaneswar, India (2014) reported Achromobacter in an acute pancreatitis patient and was found resistant to third-and fourth-generation cephalosporins, sensitive to piperacillintazobactam, meropenem and trimethoprim-sulfamethoxazole and intermediate to imipenem, levofloxacin, and tigecycline. The patient improved when treated with amikacin and piperacillin-tazobactam[7].Ucciferri C. et al reported a case of a 47-year-old lady in Italy (2021) diagnosed with common variable immunodeficiency (CVID) with positive blood culture for A. xylosoxidans along with positive cultures from peripheral and Groshong central venous catheter (CVC) which had acquired resistance to piperacillintazobactam during the course of treatment and was later treated with meropenem 3 gm/day[8].Barakat M. et al in Doha, QAT (2022) pointed out the resistance to amikacin, cefepime, ciprofloxacin, levofloxacin, and gentamycin; sensitivity to piperacillin-tazobactam, meropenem, and trimethoprimsulfamethoxazole; and intermediate pattern to ceftazidime in a patient with septicemia complicated by septic shock and multi-organ failure which led to death[9].…”

A Rare Bacteremia in a Burn Patient: A Case Report of Achromobacter Xylosoxidans and Denitrificans

“…Achromobacter xylosoxidans was first isolated and described by Yabuuchi and Ohyama in 1971. It belongs to the Alcaligenaceae family and is an aerobic, motile, oxidase-positive, non-fermenting, gram-negative bacillus [ 4 , 5 ]. In 1998, it was classified into two different subspecies, Achromobacter xylosoxidans and Achromobacter denitrificans [ 5 ].…”

“…It has been found to cause infections, particularly in immune-compromised and neutropenic patients in hospitals [ 2 ]. The microorganism can lead to clinical infections such as pneumonia, bacteremia, and meningitis [ 4 ]. Its treatment is challenging due to intrinsic and acquired resistance mechanisms [ 5 , 7 ].…”