Blood Stream Infection Caused by Achromobacter Xylosoxidans: Case Report and Review of Literature

Case Report

J Bacteriol Mycol. 2021; 8(2): 1169.

Blood Stream Infection Caused by Achromobacter Xylosoxidans: Case Report and Review of Literature

Ucciferri C1,2, Caiazzo L1, Pontolillo M1, Vignale F1, Vecchiet J1 and Falasca K1*

1Clinic of Infectious Diseases, “G. D’Annunzio” University Chieti-Pescara, Italy

2Department of Medicine and Health Sciences, University of Molise, Italy

*Corresponding author: Katia Falasca, Department of Medicine and Science of Aging, “G. D’Annunzio” University Chieti-Pescara, Clinic of Infectious Diseases, Via dei Vestini, 66100 Chieti, Italy

Received: March 16, 2021; Accepted: April 09, 2021; Published: April 16, 2021


Achromobacter xylosoxidans also known as Alcaligenes xylosoxidans is a Gram-negative bacillus found in water and soil. It is an uncommon cause of infection in immunocompetent and immunocompromised patients. This report describes a 47-year-old female diagnosed with common variable immunodeficiency with Achromobacter xylosoxidans positive blood cultures and acquired resistance to piperacillin/tazobactam during treatment. This bacterium can cause pathologies with high mortality, due to its ability to create biofilms and its particular pattern of susceptibility to antibiotics. Choosing the right antibiotic is critical because they are highly resistant to antibiotics. Due to the presence of few antibiotics with bactericidal activity, the risk of empirical treatment failure is high and therefore a correct understanding of this rare but fatal disease is important to obtain the best chance of success. For this reason we finally carried out a literature review.

Keywords: Achromobacter spp; Antibiotic resistance; Bacteremias; Common variable; Alcaligenes, immunodeficiency; Biofilm; Vascular catheter


Achromobacter xylosoxidans ss xylosoxidans (formerly Alcaligenes xylosoxidans ss xylosoxidans) is an aerobic, catalase and oxidase positive, non-fermenting gram-negative peritrichous rod; it is found usually in aqueous environments but it is still a human host, occasionally present in the skin and gastrointestinal tract [1]. A. xylosoxidans is considered an opportunistic pathogen, causing infection in immunocompromised hosts [1].

Its pathological role has well defined in literature, among dialysis patients, either in hemodialysis or in peritoneal dyalisis [2-4].

While it has been adequately outlined, until now, that A. xylosoxidans can cause nosocomial catheter-related bloodstream infection and bacteremias (outbreak or single cases), as far as we know few reports exist that describe catheter-related bloodstream infection neither in dialysis nor in oncologic patients [5].

We describe a clinical case of a patient, afflicted by common variable immunodeficiency, ulcerative colitis and coeliac disease, with a catheter-related blood stream infection sustained by A. xylosoxidans and review another cases in literature.

Case Presentation

A 47-year-old woman was admitted to our Infectious diseases ward due to a high-grade fever, chills and weakness lasting for six days. This young woman has suffered from recurring episodes of low respiratory and gastrointestinal tract infections since her childhood. At 27 years of age she was diagnosed with Common variable immunodeficiency. She had total Ig level below 100 mg/dl and a very low level of B lymphocyte, so, started a treatment with a cycle of iv Immunoglobulin every 21 days. During her adulthood, she was diagnosed with Ulcerative colitis and Coeliac disease, that lead her to important malabsorption and weight loss. Given the fact that, no matter that medication, she had been progressing to lose weight and report gastrointestinal symptoms, in February 2014, the Medical equipe she was in charge to decided to propose her the implantation of a Groshing, a vascular catheter, for total parenteral nutrition and albumin infusion. At the end of 2014 she had been hospitalized twice, first for an episode of candidaemia and then for a bacteremia from S. capitis. In 2015, a third hospital stay, due to a new Bloodstream Infection (BSI), lead to the substitution of the vascular catheter with a new one: always a Groshong. The patient had been assisted in home care regimen, with a daily visit from a professional nurse that took care of the central venous access, disinfecting it before every use. However, she occasionally needed an hospital admission, to treat and cure episodes of gastrointestinal infection. On 2017 October 25th, she was admitted to our Infectious Disease ward for a sudden appearance of high grade fever and shivering. She noticed that the elevation of the body temperature was related to the use of the Groshong catheter. At the admission, her general conditions were good. She weighted 44 kg. Blood pressure was 90/60 mmHg, heart rate was 120/min, body temperature was 39°C. Laboratory findings on admissions are shown in Table 1. The Chest x-ray was normal. First of all, peripheral and Central Venous Catheters (CVC) blood cultures were performed, then we started an empiric antimicrobial therapy with Piperacillin/ tazobactam. On the third day of hospital stay, we observed a new rise of body temperature related to the use of the Groshong catheter. We took once again peripheral and CVC blood cultures. On the seventh day of admission, we performed an echocardiography that was completely normal and ruled out vegetations either of the valve or of the Groshong. A. xylosoxidans was isolated from every single culture performed both from peripheral vein and Groshong catheter. The first series of blood cultures taken showed a bacteremia from A. xylosoxidans sensible to Piperacillin/tazobactam (Table 2), so we continued to treat her with Piperacillin/tazobactam. However, she presented again a raise in body temperature at day 10th of hospital stay and in the meantime the cultures taken on the 3rd day of admission exhibited a change in bacterial sensitivity (Table 2). While the first blood cultures showed A.xylosoxidans sensible to Piperacillin/ tazobactam, the second series of cultures revealed A.xylosoxidans resistant to Piperacillin/tazobactam. It seemed that the bacteria have developed resistance during the antibiotic treatment. So, we performed a new series of blood cultures and change the antimicrobial, shifting to Meropenem 3g/day. Even though our patient did not improve so much, continuing to present sudden episodes of malaise. We decided to perform again a Transthoracic echocardiography. The exam showed an endocarditis of the vascular catheter, reinforcing the urgent need to remove it. A regimen of enoxaparin 0.4UI twice daily was added, with resolution of the episodes of malaise reported by the patient. Once again, all the blood cultures showed A.xylosoxidans strain resistant to Piperacillin/tazobactam. Eventually we continued the antimicrobial until the transfer of the patient to the Hospital in which she substituted the catheter with a new one.