Chest Infections |

Disseminated Achromobacter xylosoxidans Infection in an Immunocompromised Host FREE TO VIEW

Naveed Hasan*, MD; Mani Kavuru, MD
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Thomas Jefferson University Hospital, Philadelphia, PA

Chest. 2012;142(4_MeetingAbstracts):170A. doi:10.1378/chest.1388921
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SESSION TYPE: Infectious Disease Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: A. xylosoxidans is a catalase-positive, oxidase-positive, gram-negative bacillus that inhabits a variety of aqueous environments. It has been described as small outbreaks as well as in immunocompromised hosts. We describe a case of disseminated A. xylosoxidans infections in patient on Rituximab treatment.

CASE PRESENTATION: 56 year old woman was admitted to the hospital for fever and progressive dyspnea over 2 weeks. Her past medical history was significant for Mantle cell lymphoma status post autologous stem cell transplant (SCT) in 2009 and haploidentical SCT in 2010. She was on Rituximab through her right chest port for recurrence of lymphoma in her right hip. Her temperature was 103 degree fahrenheit and she had a leucocytosis of 14,000/microL. Chest roentgenogram showed a new left loculated effusion. Initial blood cultures were positive for gram negative rods. Echocardiogram showed a large pericardial effusion. She was started on intravenous vancomycin and aztreonam (she was penicillin allergic). Her respiratory status deteriorated quickly requiring mechanical ventilation. Left sided thoracentesis was performed, the fluid was exudative and grew A. Xylosoxidans. Blood cultures finalized to be A. Xylosoxidans as well. The organism was oxidase positive and grew in anaerobic bottle only. It was resistant to aztreonam and ciprofloxacin, while sensitive to gentamicin, ceftazidime, meropenem and tobramycin. The patient was managed with switching aztreonam to intravenous meropenem. A video assisted thoracoscopic surgery, left chest decortication, pericardial window and port removal was done in the operating room. Pericardial fluid also grew A. xylosoxidans. A right pleural effusion later developed which was managed with therapeutic thoracentesis; fluid was sterile. Further ICU course included tracheostomy and gastrostomy tube placement followed by a prolonged hospitalization and discharge to rehabilitation.

DISCUSSION: A. Xylosoxidans is a very uncommon cause bacteremia. The mortality is reportedly low with catheter related bacteremia but high with clinical syndromes like pneumonia and endocarditis. In our case, the infection was likely port related but resulted in acute respiratory distress syndrome from pneumonia; and empyema, requiring surgical treatment. Pericarditis with A. xylosoxidans bacteremia has not been previously reported. The organism is known to be resistant to aminoglycosides but was sensitive in our case. The severity of illness, development of pericarditis, sensitivity pattern and good clinical outcome are unique to our case.

CONCLUSIONS: A. Xylosoxidans bacteremia in an immunocompromised host can be life threatening. Pneumonia, empyema and pericarditis are potential complications. Choice of intravenous antibiotics and surgical management as appropriate are important for a favorable outcome.

1) Duggan et al, Achromobacter xylosoxidans bacteremia: Report of four cases and review of literature. Clin Inf Dis 1996;23 569-76

DISCLOSURE: The following authors have nothing to disclose: Naveed Hasan, Mani Kavuru

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Thomas Jefferson University Hospital, Philadelphia, PA




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