Achromobacter xylosoxidans bacteremia in a patient with streptomycin-resistant tuberculosis: A case report

Abstract

Introduction Achromobacter xylosoxidans can be found in both community and hospital environments. It can cause infection in immunocompromised patients and has many intrinsic characteristics that increase its likelihood of acquiring antibiotic resistance. Consensus guidelines on A. xylosoxidans treatment still remains a challenge; therefore, antibiotic choice must be considered by physician according to individual drug susceptibility patterns. In August 2020, the reported case, 50-year-old Thai male farmer presented to the emergency room of Kaeng Khro Hospital in Chaiyaphum, Thailand, , after experiencing fever with dyspnea for 3 days. He was a smoker (20 pack-years). He had a history of smear-positive pulmonary tuberculosis first diagnosed in 2017 with treatment completed. He had experienced a relapse of pulmonary tuberculosis in November 2018. Mycobacterium tuberculosis grew from sputum culture revealed its resistance to streptomycin. He had been lost to follow-up after 6 weeks of treatment. During this hospital course, he was diagnosed with acute respiratory failure and sepsis, and received endotracheal intubation and intravenous ceftazidime. Blood culture grew A. xylosoxidans with its antibiotic susceptibility pattern showing resistance to gentamicin, cefotaxime, and ceftriaxone, and intermediate resistance to netilmicin. Despite treatment, he died due to respiratory failure. Conclusion There is no evidence showing that pulmonary tuberculosis increase the risk of A. xylosoxidans infection, but bronchiectasis from inadequate tuberculsosis treatment and pulmonary scarring possibly increase the risk of the opportunistic infection in lung and blood stream. Although A. xylosoxidans infection is rare, it is clinically important because of its high mortality rate. In immunocompromised individuals presenting with infection, we should include A. xylosoxidans infection in the differential diagnosis.