Achromobacter xylosoxidans/denitrificans bacteremia and subsequent fatal Escherichia coli/Streptococcus anginosus pleural empyema

Abstract

Achromobacter xylosoxidans, a gram-negative bacillus with low virulence has rarely been reported to cause clinically significant infections. We report an unusual case of MDR Achromobacter xylosoxidans/denitrificans bacteremia from a peripherally inserted central catheter (PICC) and subsequent fatal pleural empyema due to MDR Escherichia coli and Streptococcus anginosus. A 44-year-old male presented to the hospital with chief complaints of chest tightness associated with a productive cough. He was found to have pleural empyema secondary to MDR E. coli and S. anginous. Three months prior to current presentation, he had a history of MDR A. xylosoxidans originating from a PICC. The patient expired even after appropriate management. Thoracic empyema continues to cause significant morbidity and mortality despite the improvement of antimicrobial therapy and the existence of multiple options for drainage of the infected pleural space. The bacteriology of thoracic empyema has been changing since the introduction of antibiotics. Typical antibiotics used to treat these MDR pathogens have become obsolete. Therefore, physicians should be aggressive in their diagnostic approach to pleural empyema, since the isolation of MDR aerobic gram-negative bacilli or multiple pathogens from the pleural fluid is associated with a poor prognosis and indicates a need for more aggressive antimicrobial chemotherapy. Also, the association of indwelling medical devices and MDR Achromobacter bacteremia should be known.

The State of Microbiological Cleanliness of Surfaces and Equipment of an Endoscopic Examination Laboratory—Data from a Reference Tertiary Clinical Endoscopy Center in Southern Poland

“…Achromobacter denitrificans bacillus is a Gram-negative, obligatory aerobic bacterium that often lives in soil, human intestines and in the aquatic environment, e.g., in contaminated intravenous fluids or water in air humidifiers [ 27 , 49 , 50 , 51 ]. In hospital conditions, infections caused by this microorganism are associated with the use of humidifiers and incubators.…”

“…Symptomatic infection may appear as endocarditis, meningitis, pneumonia, peritonitis, conjunctivitis, osteomyelitis, and urinary tract or wound infection. Invasive Achromobacter denitrificans infections can be fatal in immunocompromised individuals [ 49 , 50 , 51 ].…”

A Rare Cause of Infection, Achromobacter xylosoxidans

“…A. xylosoxidans'ın neden olduğu nozokomiyal infeksiyonlar, yüksek morbidite ve mortalite ile ilişkili bulunmuştur. Bu infeksiyonların tedavisi yüksek direnç oranlarından dolayı oldukça zordur [1] . Literatürde bu bakteri hakkında yapılan çalışmalar genellikle çok küçük seriler ve tek olgu raporlarından oluşmaktadır [8] .…”

“…Achromobacter türleri, birinci ve ikinci kuşak sefalosporinler, aminoglikozidler ve dar spektrumlu penisilinlere karşı oldukça dirençlidir. Sülfonamidlere, karbapenemlere ve geniş spektrumlu penisi- linlere, üçüncü kuşak sefalosporinlere ve florokinolonlara karşı ise duyarlı oldukları bildirilmiştir [1] . Bu nedenle bu infeksiyonların tedavisinde sıklıkla bu ajanlar tercih edilmektedir [10] .…”

“…Achromobacter xylosoxidans, hem bağışıklık sistemi sağlam hem de immünyetmezlikli kişilerde yeni bir infeksiyon etkeni olarak ortaya çıkan düşük virülanslı gram-negatif basildir [1] . Aerop, nonfermentatif, gram-negatif basil olan A. xylosoxidans, ilk olarak 1971 yılında Yabuuchi ve Oyama tarafından kronik otitis medialı yedi hastada izole edilmiş ve Alcaligenes xylosoxidans olarak isimlendirilmiştir [2,3] .…”