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LETTER TO EDITOR  
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 85
Native valve endocarditis in a dialysis patient by Achromobacter xylosxidans, a rare pathogen


Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA

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Date of Web Publication24-May-2017
 

How to cite this article:
Kumar S, Khaira J, Penigalapati D, Apurva A. Native valve endocarditis in a dialysis patient by Achromobacter xylosxidans, a rare pathogen. J Global Infect Dis 2017;9:85

How to cite this URL:
Kumar S, Khaira J, Penigalapati D, Apurva A. Native valve endocarditis in a dialysis patient by Achromobacter xylosxidans, a rare pathogen. J Global Infect Dis [serial online] 2017 [cited 2018 Sep 21];9:85. Available from: http://www.jgid.org/text.asp?2017/9/2/85/204692


Sir,

A 54-year-old male presented with generalized weakness, body ache, and fever for 2 weeks. No history of pharyngitis, dyspnea, chest pain, and bowel/bladder complaints. He was on hemodialysis for end-stage renal disease secondary to hypertension. T, 102.3 F; heart rate, 115/min; respiratory rate, 12/min; and blood pressure, 137/80 mmHg. Grade II/VI pansystolic murmur at mitral region, radiating to the left axilla was noticed. Two-dimensional Echocardiogram showed aortic and mitral vegetations with mitral regurgitation, confirmed by transesophageal echocardiography. Blood culture isolated Achromobacter xylosoxidans sensitive to piperacillin-tazobactam, ceftazidime and resistant to ampicillin, gentamicin, imipenem, and aztreonam. Accordingly, piperacillin-tazobactam was used but repeat blood cultures at 48 h grew the same pathogen. Despite 2 weeks of antibiotics, bacteremia persisted without resolution of vegetations. Cardiovascular surgery was consulted for prosthetic valve replacement. A. xylosoxidans has been cultured from indwelling catheters, endotracheal, and shunt tubings.[1] Several case reports show transmission from contaminated water and the unhygienic hands of healthcare workers.[2] It also causes bacteremia in dialysis-dependent patients.[3] Our patient was on hemodialysis and possibly infection occurred consequent to cross-contamination due to poor hygienic practices. The characteristic antimicrobial pattern of A. xylosoxidans includes resistance to aminoglycosides, narrow-spectrum penicillins, cephalosporins, and aztreonam.[4],[5] Eradicating this bacteria is extremely difficult, especially in endocarditis where the resistant microcolonies are enmeshed with fibrin and platelet strands. In retrospect, we believe that we could have added gentamicin as some in vitro studies suggest gentamicin with beta-lactams may be synergistic, despite a high level of resistance to aminoglycosides.[3]

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Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sawant AC, Srivatsa SS, Castro LJ. Alcaligenes xylosoxidans endocarditis of a prosthetic valve and pacemaker in a 62-year-old woman. Tex Heart Inst J 2013;40:95-8.  Back to cited text no. 1
[PUBMED]    
2.
Kim MJ, Bancroft E, Lehnkering E, Donlan RM, Mascola L. Alcaligenes xylosoxidans bloodstream infections in outpatient oncology office. Emerg Infect Dis 2008;14:1046-52.  Back to cited text no. 2
    
3.
Ahmed MS, Jayan R, Kuduvalli M, Anijeet HK. Achromobacter xylosoxidans, an emerging pathogen in catheter-related infection in dialysis population causing prosthetic valve endocarditis: A case report and review of literature.Clin Nephrol 2009;71:350.  Back to cited text no. 3
[PUBMED]    
4.
van Hal S, Stark D, Marriott D, Harkness J. Achromobacter xylosoxidans subsp. xylosoxidans prosthetic aortic valve infective endocarditis and aortic root abscesses. J Med Microbiol 2008;57(Pt 4):525-7.  Back to cited text no. 4
    
5.
Derber C, Elam K, Forbes BA, Bearman G. Achromobacter species endocarditis: A case report and literature review. Can J Infect Dis Med Microbiol 2011;22:e17-20.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Shweta Kumar
Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.204692

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008