Abstract
Achromobacter xylosoxidans has been reported in several countries; however, hospital-acquired pneumonia (HAP) due to this organism in elderly patients in China remains rare. HAP due to Achromobacter xylosoxidans identified at the General Hospital of the People's Liberation Army in Beijing from January 2008 to October 2011 was studied. Detailed clinical manifestations were collected. To study the clinical risk factors for the imipenem-resistant strain, patients were divided into two groups: imipenem-resistant (21 cases) and imipenem-nonresistant (20 cases). Univariate and multivariate logistic regression were used. All patients were > 75 years of age, and 92.7% (38/41) were male. Nine patients died 30 days after infection. The mean acute physiology and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) were 23.66 ± 7.71 and 6.93 ± 2.47, respectively. Almost all strains were resistant to aminoglycosides. However, the strains showed significant sensitivity to minocycline (MIN), piperacillin-tazobactam (PTZ), and cefoperazone-sulbactam (SCF). Compared with the imipenem-nonresistant group, more patients with imipenem-resistant infection had the following characteristics: use of an intubation, use of a proton-pump inhibitor (PPI), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CHD). Among the four risk factors, COPD and CHD remained independent risk factors in the multivariate analysis. HAP due to Achromobacter xylosoxidans occurred in severely ill elderly patients with a long-term indwelling catheter and many underlying diseases. Effective treatment of imipenem-resistant organisms is challenging. SCF, PTZ, and MIN may be useful for imipenem-resistant Achromobacter xylosoxidans.
Highlights
Achromobacter xylosoxidans has been reported in several countries; hospital-acquired pneumonia (HAP) due to this organism in elderly patients in China remains rare
The aim of this study was to illustrate the underlying diseases, the clinical manifestations, and outcome; to review the susceptibility of this organism to various antibiotics; and to discuss risk factors associated with imipenem resistance in patients with HAP due to Achromobacter xylosoxidans
Thirty-one (75.6%) patients were being treated with a proton-pump inhibitor (PPI), and 5 (12.2%) patients were receiving corticosteroids
Summary
Achromobacter xylosoxidans has been reported in several countries; hospital-acquired pneumonia (HAP) due to this organism in elderly patients in China remains rare. To study the clinical risk factors for the imipenemresistant strain, patients were divided into two groups: imipenem-resistant (21 cases) and imipenem-nonresistant (20 cases). Compared with the imipenem-nonresistant group, more patients with imipenem-resistant infection had the following characteristics: use of an intubation, use of a proton-pump inhibitor (PPI), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CHD). Achromobacter xylosoxidans has been reported in several countries It is an oxidase-positive, catalasepositive, and highly motile non-fermenting Gramnegative bacterium that was first isolated from ear discharge and reported by Yabuuchi and Oyama [1]. Patients who exhibit weakened immunity and malnutrition frequently have chronic infections and are frequently exposed to antibiotics, often resulting in the emergence of multidrug-resistant organisms. Insertion of blaIMP into plasmids in Achromobacter xylosoxidan has been described, potentially facilitating the spread of carbapenem-resistant strains [10]
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