Achromobacter Infections and Treatment Options

Abstract

Achromobacter is a genus of non-fermenting Gram negative bacteria under order Burkholderiales. Although primarily isolated from respiratory tract of people with cystic fibrosis, Achromobacter spp. can cause a broad range of infections in hosts with other underlying conditions. Their rare occurrence and ever-changing taxonomy hinder defining their clinical features, risk factors for acquisition and adverse outcomes, and optimal treatment. Achromobacter spp. are intrinsically resistant to several antibiotics (e.g. most cephalosporins, aztreonam and aminoglycosides), and are increasingly acquiring resistance to carbapenems. Carbapenem resistance is mainly caused by multidrug efflux pumps and metallo-β-lactamases, which are not expected to be overcome by new β-lactamase inhibitors. Among the other new antibiotics, cefiderocol and eravacycline were used as salvage therapy for a limited number of patients with Achromobacter infections. In this article, we aim to give an overview of the antimicrobial resistance in Achromobacter species, highlighting the possible place of new antibiotics in their treatment.

Achromobacter xylosoxidans and Stenotrophomonas maltophilia: Emerging Pathogens Well-Armed for Life in the Cystic Fibrosis Patients’ Lung

“…Otherwise, therapy should be guided by antimicrobial susceptibility testing results. For Axc , the most active agents beside co-trimoxazole are minocycline, meropenem, or imipenem, piperacillin-tazobactam, ceftazidime, and/or chloramphenicol, depending on the study [ 150 , 151 , 152 , 153 ]. For Sm , chloramphenicol, minocycline, or doxycycline can be considered for the treatment, as well as ticarcillin-clavulanate, ceftazidime, and levofloxacin, for which clinical breakpoints are available.…”

Role of RND Efflux Pumps in Drug Resistance of Cystic Fibrosis Pathogens

“…The substrates and the family of the other six pumps have yet to be determined. A comparative genomic analysis showed that the genes coding for most of these nine systems are conserved among different A. xylosoxidans strains [34], with one of them, axyABM, conserved in all the sequenced Achromobacter genomes [36], while axyXY-oprZ has been found also in Achromobacter ruhlandii [37]. Regarding proteins belonging to the HME family, RND transport systems homologous of CzcABC and CusABC are present in the genomes of other Achromobacter strains [38,39].…”

Coming from the Wild: Multidrug Resistant Opportunistic Pathogens Presenting a Primary, Not Human-Linked, Environmental Habitat

“…These bacteria can cause bacteraemia, meningitis and urinary tract infections [ 323 , 324 , 325 ]. Moreover, Achromobacter genus-belonging bacteria have also been isolated from CF patients [ 326 , 327 , 328 ]. Achromobacter xylosoxidans is the predominantly reported species among CF clinical isolates [ 322 ], but other Achromobacter species have also been isolated from these patients, such as Achromobacter ruhlandiiand [ 329 ].…”

“…Achromobacter xylosoxidans is the predominantly reported species among CF clinical isolates [ 322 ], but other Achromobacter species have also been isolated from these patients, such as Achromobacter ruhlandiiand [ 329 ]. They are intrinsically resistant to several drugs [ 328 ] due to the presence in their genomes of genes encoding RND MDR efflux pumps that extrude cephalosporins, aztreonam, carbapenems, quinolones, chloramphenicol, tetracyclines and erythromycin [ 330 , 331 ], as well as to the activity of β-lactamases [ 332 , 333 ]. Moreover, they are becoming increasingly resistant to carbapenems [ 328 ].…”

“…They are intrinsically resistant to several drugs [ 328 ] due to the presence in their genomes of genes encoding RND MDR efflux pumps that extrude cephalosporins, aztreonam, carbapenems, quinolones, chloramphenicol, tetracyclines and erythromycin [ 330 , 331 ], as well as to the activity of β-lactamases [ 332 , 333 ]. Moreover, they are becoming increasingly resistant to carbapenems [ 328 ]. Furthermore, a recent study has described patient-to-patient transmission and AR development in different Achromobacter species [ 334 ].…”