背景:本报告描述了免疫功能低下患者中反复发生的木氧氧曲霉血流和PICC(外周中心导管)线感染。
方法:一名64岁女性,在非中性粒细胞减少性发热发作期间出现急性早幼粒细胞白血病,并且从多个PICC和外周血培养物中分离出木洛昔丹菌,从移除线的尖端开始。患者接受美罗培南治疗,并在无菌血液培养后插入新的PICC线。六周后,她代表来自该系列多种文化的A.xylosoxidans。她接受了哌拉西林他唑巴坦治疗,并拔除了管路。没有深部感染的证据。进一步的讨论显示,患者正在使用海绵清洁,洗澡时用袖子盖住她的PICC线。从海绵和拭子中培养木酮糖。对分离的两个血液培养物和两个环境分离物进行的全基因组测序证实所有四个分离物是不可区分的。建议患者将来不要使用海绵/套筒,我们已将这方面的具体建议纳入患者信息中。
结论:木氧化无色杆菌是一种需氧,非乳糖发酵革兰阴性杆菌通常被认为是机会致病菌。它与免疫功能低下患者的感染有关,并且是导管相关感染的新兴病原体,有时与受污染的水有关。
结论:此例反复发生的木糖氧炎杆菌线感染突出了与导管相关感染相关的诊断和管理挑战。由于内在和获得性耐药机制,治疗具有挑战性。通常需要使用抗假青霉素或碳青霉烯类抗生素进行经验性治疗,并去除管路。
BACKGROUND: This report describes recurrent A. xylosoxidans bloodstream and PICC (peripherally-inserted central catheter) line infection in an immunocompromised patient.
METHODS: 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.
CONCLUSIONS: 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.
CONCLUSIONS: 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.