Abstract
Achromobacter species are isolated from rare but severe healthcare-associated infections, including surgical site infections. They are considered to preferentially infect immunocompromised patients but so far with limited evidence. We conducted a systematic review on Achromobacter spp. surgical site infections (SSIs) to determine if such infections were indeed more commonly associated with immunocompromised patients. The secondary objective was to describe the characteristics of infected patients. Eligible articles had to be published before 30 September 2020 and to report Achromobacter spp. SSIs across all surgical specialties excluding ophthalmology. Analyses were performed on individual data without meta-analysis. Cases were divided into 2 subgroups: one group which had either prosthesis or implant and the other group which did not. A first selection led to a review of 94 articles, of which 37 were analyzed. All were case reports or case series and corresponded to 49 infected patients. Most of the patients were under 65 years of age and had undergone a heart or digestive surgery followed by deep infection with no co-infecting pathogens. Nine out of the 49 cases were immunocompromised, with similar distribution between the two subgroups (16.6% and 20%, respectively). This review suggests that Achromobacter spp. SSIs do not preferentially target immunocompromised patients.
Highlights
Surgical Site Infections (SSIs) are a major cause of increased morbidity and mortality, prolonged hospital length of stay, hospital readmissions, and increased health care costs in surgical patients [1]
Prevalence Survey (NINPS), surgical site infections (SSIs) accounted for 20% of all the Healthcare-Associated Infections (HAIs) in 2017 in the metropolitan and the overseas regions of France and represented the second most common HAI after the urinary tract infections [2]
Search terms were defined by two independent researchers and adapted to each repository by combining vocabulary, relevant MeSH terms, and keywords such as “Achromobacter”, “Alcaligenes xylosoxidans”, “surgery”, “surgical site infection”, “wound infection“, “nosocomial infection”, ” healthcare-associated infection”, “bacteraemia”, “endocarditis”, “meningitis”, “bacteraemia”, “ventriculitis”, “mediastinitis”,” abscess”, “peritonitis”, “burns”
Summary
Surgical Site Infections (SSIs) are a major cause of increased morbidity and mortality, prolonged hospital length of stay, hospital readmissions, and increased health care costs in surgical patients [1]. The bacteria commonly isolated in SSIs are Staphylococcus aureus and Enterobacteriaceae, but environmental bacteria such as Pseudomonas aeruginosa account for a significant proportion of the agents involved in such infections [3]. Described as low-virulence and sporadic contaminants, these bacteria have been emerging in health care facilities for the past few decades. Knowledge about these microorganisms is continuously increasing [10] with some virulence factors identified [11] and some case reports describing severe infections with fatal outcomes [11,12,13,14,15]. Most authors present Achromobacter spp. as an opportunistic pathogen that preferentially infects immunocompromised patients, but so far with insufficient amounts of evidence [6,16,17,18,19,20,21,22]
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