Achromobacter spp. are Gram-negative water-borne bacteria occasionally causing bacteremia mainly in immunocompromised hosts. Cancer patients have increased risk due to their use of intravascular catheters and immunosuppression from neoplasm, chemotherapy, and prolonged steroids.
We retrospectively reviewed all cases of Achromobacterbacteremia occurring from March 2010 to March 2015 at the Moffitt Cancer Center.
Eleven patients were identified with positive blood cultures for Achromobacter xylosoxidans, ten of them spp xylosoxidans, one spp denitrificans. Five patients had solid tumors and six patients had hematologic malignancies with acute myeloid leukemia being the most frequent. No predominant comorbidity was found. Six patients were on steroids. Three patients were neutropenic at diagnoses. The mean age was 52 years, seven were males. All patients had SIRS, one patient presented with septic shock. Five infections were nosocomial. Eight (72.7%) patients had a history of prior bacteremia, one of then with Achromobacter anthropic bacteremia two years prior. Three patients (27%) had polymicrobial infection, one of them with Candida albicans. Central venous catheters were infected in nine patients (82%) and two patients had recurrent bacteremia, which resolved after removal of the catheter.
One patient died during the hospital stay and three were discharged to hospice. The median length of hospital stay was 32 days. The isolates were susceptible to carbapenems (Meropenem 8 of 8 isolates, Imipenem 3 of 4 with 1 isolated intermediate), Piperacillin/Tazobactam (10 of 10), Ceftazidime (7 of 7) and Trimethoprim/Sulfametoxazole (8 of 8); most of isolates were resistant to aminoglycosides (including Gentamycin, Amikacin and Tobramycin) and fluoroquinolones.
In this case series risk factors for Achromobacter bacteremia were infected intravascular catheters and prior history of bacteremia. Infections can be treated with a single agent such as Piperacillin/tazobactam, a carbapenem or Trimethoprim/Sulfamethoxazole. Compared with other series of Achromobacter, we saw similar risk factors, morbidity and concomitant bacteremia and fungemia but with higher rate of intravascular catheters infections.
J. Paruolo, None
K. Kynaston, None
T. Stutzman, None
A. Velez, None
J. Greene, None