Background: This report describes recurrent A. xylosoxidans bloodstream and PICC (peripherally-inserted central catheter) line infection in an immunocompromised patient.
Presentation of case: A 64-year-old female with acute promyelocytic leukaemia presented during a non-neutropenic febrile episode, and A. xylosoxidans was isolated from multiple PICC and peripheral blood cultures, and from the tip of the line on removal. The patient was treated with meropenem and a new PICC line was inserted after sterile blood cultures. Six weeks later, she represented with A. xylosoxidans from multiple cultures from the line. She was treated with piperacillin-tazobactam and the line was removed. There was no evidence of deep-seated infection. Further discussion revealed that the patient was using a sponge to clean, and a sleeve to cover her PICC-line while bathing. A. xylosoxidans was cultured from both the sponge and the swab. Whole Genome Sequencing performed on two blood culture isolated and both environmental isolates confirmed all four isolates were indistinguishable. The patient was advised not to use the sponge/sleeve in future and we have incorporated specific advice in this regard into our patient information.
Discussion: Achromobacter xylosoxidans is an aerobic, non-lactose fermenting gram-negative bacillus usually considered an opportunistic pathogen. It is associated with infection in immunocompromised patients, and is an emerging pathogen in catheter-related infections, sometimes associated with contaminated water.
Conclusion: This case of recurrent A. xylosoxidans line infection highlights diagnostic and management challenges associated with catheter-related infections. Treatment is challenging because of intrinsic and acquired resistance mechanisms. Empiric treatment with anti-pseudomonal penicillins or carbapenems with line removal is typically required.
Keywords: AIDS, acquired immune deficiency syndrome; ANC, absolute neutrophil count; APML, Acute promyelocytic leukaemia; ATRA, All-trans-retinoic acid; Achromobacter xylosoxidans; CF, cystic fibrosis; CLED, cystine-lactose-electrolyte deficient; CLSI, Clinical Laboratory Standards Institute; CRP, C-reactive protein; ESBL, extended-spectrum beta-lactamase; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MALDI-TOF, matrix-assisted laser desorption/ionization time-of-flight; MIC, minimum inhibitory concentration; MLST, multilocus sequence typing; Opportunistic infection; PICC, Peripherally-inserted central catheter; Peripheral-inserted central catheter infection; Recurrent bacteraemia; SNP, single nucleotide polymorphisms; WCC, white cell count; WGS, Whole genome sequencing; Water-borne pathogen; rMLST, Ribosomal multi-locus sequence typing; rRNA, ribosomal ribonucleic acid.
© 2022 The Authors.