Achromobacter species endocarditis: A Case Report and Literature Review

Abstract

Endocarditis due to Achromobacter species is a rare, yet serious, endovascular infection. Achromobacter species infective endocarditis is associated with underlying immunodeficiencies or prosthetic heart valves and devices. A case of prosthetic pulmonary valve endocarditis secondary to Achromobacter xylosoxidans subspecies denitrificans is described in the present report. This life-threatening infection was successfully treated with combined valve replacement and prolonged antibiotic therapy. A Medline/PubMed literature review of Achromobacter endocarditis was also performed. Achromobacter species are an uncommon, yet important, cause of nosocomial endocarditis. Given the significant associated morbidity and mortality, along with a high degree of intrinsic antibiotic resistance, Achromobacter species infective endocarditis remains a clinical treatment challenge.

Achromobacter Respiratory Infections

“…In contrast to Claassen and colleagues, we found only one definitive case of IgM deficiency among the 32 cases reviewed, and only one subject with diabetes mellitus and chronic kidney disease (16,56). The latter finding differs significantly from other achromobacterial infections, such as bacteremia, urinary tract infection, and endocarditis, in which diabetes mellitus and chronic kidney disease were shown to be common comorbidities (17,(21)(22)(23)(24)(25).…”

“…However, certain species, most notably xylosoxidans and denitrificans, can cause disease in certain patient populations, such as subjects with cystic fibrosis, hematologic and solid organ malignancies, renal failure, and immunodeficiencies (8)(9)(10)(11)(12). The most frequent clinical isolate is xylosoxidans, which can infect any number of organ systems, and is increasingly recognized as an important emerging nosocomial pathogen (13)(14)(15)(16)(17)(18)(19). Recent comparative genomic sequencing by Li and colleagues (6) has shown that not all members of the genus share human virulence factors, and that there are distinct genetic sequences among certain members of the xylosoxidans species that impart the ability to both colonize the human respiratory tract, and subsequently evade host defenses (20).…”

“…In brief, published reports and literature reviews have demonstrated achromobacterial pneumonia, bacteremia, urinary tract infections, gastrointestinal infections, endocarditis, meningitis, and ophthalmic disease (17,(21)(22)(23)(24)(25). The vast majority of information regarding achromobacterial respiratory disease pertains to subjects with cystic fibrosis, although isolated cases of non-cystic fibrosis community and nosocomially acquired pneumonia have previously been reported (Table 1).…”

Prosthetic Valve Endocarditis with aortic root abscess

“…While PVe due to Achromobacter xylosoxidans subsp xylosoxidans has been reported in few cases 3,8,10,11 we found only one reported case of PVe due to Achromobacter xylosoxidans subsp denitrificans. 9 the other documented clinical manifestations of infections caused by this pathogen include primary bacteremia, pneumonia, renal abscess, 12 prosthetic valve endocarditis, cholecystitis, peritonitis, keratitis 13 and meningitis. 14 Characteristic antimicrobial susceptibility patterns of A. xylosoxidans subsp.…”

“…denitrificans is generally susceptible to ceftazidime, extended spectrum penicillins, carbapenems and sulphonamides where as susceptibility to quinolones is variable. 9,12 though the most appropriate antimicrobial therapy has not been determined against A. xylosoxidans subsp. denitrificans, levofloxacin, meropenem and co-trimoxazole were effective in our patient, as was also the experience in other studies.…”