Summary
Achromobacter xylosoxidans is a microorganism found in the nature, soil and water. It may cause opportunistic infections in immunosuppressed patients. It may lead rarely to urinary system infections in patients with underlying urinary abnormalities. We report a case of urosepsis due to A. xylosoxidans in a 59-year-old female patient having had total bilateral salpingo-oophorectomy seven years ago due to the diagnosis of endometrial clear cell carcinoma.
Introduction
Achromobacter xylosoxidans is a Gram-negative aerobic, oxidase-positive bacterium that can be found in soil and water in nature[1, 2]. It may lead to opportunistic infections, such as bacteremia, meningitis, pneumonia and peritonitis, especially in patients with underlying diseases and immunosuppression[2]. Although it is not a frequently seen non-fermentative bacillus, there are several reports describing nosocomial infections by means of contamination of some medical solutions, such as dialysis fluid, chlorhexidine, and deionized water[3, 4]. In addition, A. xylosoxidans has gained more importance recently since it may be resistant to cephalosporins, aminoglycosides, and quinolones[5, 6]. In this paper, we present a case of urosepsis due to A. xylosoxidans.
Discussion
A. xylosoxidans has been reported to show high-level of resistance to cephalosporins (>90%), aminoglycosides (>90%) and quinolones (>80%)[13]. In a study performed by Aisenberg et al.[11], all the isolates were susceptible to meropenem and piperacillin-tazobactam; 98%, 94% and 87% were susceptible to ticarcillin-clavulanic acid, trimethoprim-sulfamethoxazole and imipenem, respectively. More than 90% of isolates were resistant to cephalosporins (Except for ceftazidime and cefoperazone; susceptibility rates of 92% and 96% respectively) 94% were resistant to aztreonam, 92% - to tobramycin, 89% - to gentamicin and 90% were resistant to amikacin[11]. Tena et al.[12] demonstrated that all isolates were susceptible to imipenem and piperacillin-tazobactam, 88.8% to ceftazidime and 77.7% were susceptible to trimethoprim-sulfamethoxazole, whereas all the isolates were resistant to ampicillin and cefuroxime, 89% - to norfloxacin, 78% - to ciprofloxacin, and 67% were resistant to gentamicin[12]. Turel et al.[6], reported an A. xylosoxidans-related outbreak in a newborn intensive care unit. Thirty-four isolates were identified and all of them were susceptible to meropenem and trimethoprim-sulfamethoxazole, 91% - to piperacillintazobactam, 82% - to ciprofloxacin and ceftazidime, 15% - to cefepime and, none of them were susceptible to gentamicin[6]. Susceptibility pattern of the isolate in our case was similar to the results reported by Aisenberg et al.[11], Tena et al.[12] and Turel et al.[6]. Empirical treatment with cefuroxime was initiated by a physician who was not an infectious diseases specialist and it was not an appropriate drug in this case. After the consultation with infectious diseases specialists, the antibiotherapy was switched to meropenem. The patient recovered completely with meropenem for seven days followed by oral co-trimoxazole therapy for an additional two weeks[11, 12].
In conclusion, A. xylosoxidans is an opportunistic pathogen that may cause infections, such as bacteremia, meningitis, and pneumonia in patients with immunosuppression and underlying diseases. It may also lead to urosepsis in patients with underlying urinary abnormalities. Infections due to A. xylosoxidans should be considered in oncology, dialysis, and newborn intensive care units, since it may lead to morbidity and mortality in this group of patients.
Ethics
Informed Consent: Consent form was filled out by the presented case.
Authorship Contributions
Surgical and Medical Practices: Aslıhan Demirel, Haluk Akpınar, Data Collection or Processing: Aslıhan Demirel, Interpretation: Aslıhan Demirel, Nur Efe İris, Literature Search: Aslıhan Demirel, Writing: Aslıhan Demirel.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study has received no financial support.