We report a case of A. xylosoxidans pneumonia and bacteremia in a 67-year-old male who presented to the emergency room with a 2-day history of hemoptysis. Four days prior to his presentation, he starts to cough, for which he saw his primary care doctor. As his INR at that time was high, he was told to stop his Coumadin for a day or two. The next day, he started coughing up blood and was brought to the ER. At arrival, his BP was 152/58 mm Hg, PR 88/min, afebrile, tachypneic with mild respiratory distress. Pertinent examination include bibasilar crackles with diffuse ronchi and a large, 8 cm by 4 cm superficial ulcer of the right leg over the anterior tibial bone with purulent foul-smelling drainage from the wound. Chest CT revealed bilateral infiltrates and underlying interstitial disease. He was started on intravenous moxifloxacin. As the patient was coughing blood and become febrile, an infectious disease consult was obtained. The patient was started on empiric therapy with imipenem and vancomycin for pneumonia and right leg cellulitis. Sputum and blood culture grew Achromobacter xylosoxidans SS xylosoxidans. Microorganism was sensitive to imipenem but resistant to many antibiotics. Over the next 2-3 days, the patient clinically improved significantly.
Discussion Achromobacter xylosoxidans was first described by Yabuuchi and Ohyama in 1971. Phylogenetically and biochemically, Achromobacter is closely related to the genus Brucella. The bacterium is an aerobic, motile gram-negative bacillus that is oxidase and catalase positive. It is usually found in soil and water and can occasionally be recovered from the respiratory and the GI tract, mostly in individuals with health care contact. Infections with Achromobacter have been described in various clinical settings both in immunocompromised and nonimmunocompromised patients. Isolates have been recovered from blood, peritoneal fluids, pleural fluids, urine, respiratory secretions, and wound exudates. Bacteremia, often related to intravascular catheters, has been reported as well. Biliary tract sepsis, meningitis, pneumonia, peritonitis, urinary tract infection, osteomyelitis, prosthetic knee infection, and prosthetic valve endocarditis have also been reported. Mortality is reported to be about 15%. Risk factors associated with increased mortality were neutropenia and age over 65.
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