ACHROMOBACTER-XYLOSOXIDANS BACTEREMIA - REPORT OF 4 CASES AND REVIEW OF THE LITERATURE

Seventy-seven cases of bacteremia due to Achromobacter xylosoxidans we re reviewed, and susceptibility studies were performed on 11 clinical isolates of A. xylosoxidans. Nosocomial bacteremia was noted in 54 of 77 patients (70%), and 28 (36%) had infection associated with an outbr eak or acquired from a discrete point source. The most common underlyi ng illnesses were malignancies (30%) and cardiac disease (21%); immuno suppression affected 27%. The most common clinical syndromes were prim ary and catheter-associated bacteremia (19% each) and pneumonia (16%). The case-fatality rate was 30%; only 3% of patients with primary or c atheter-associated bacteremia died, but 65% of patients with meningiti s, endocarditis, and pneumonia died. The case-fatality rate in neonate s was 80%. Susceptibility studies showed that all strains were resista nt to aminoglycosides, most were resistant to quinolones, and all were susceptible to broad-spectrum penicillins, imipenem, ceftazidime, and trimethoprim-sulfamethoxazole. Two-disk approximation and time-kill s tudies showed synergy or additive effects for the combination of genta micin and piperacillin against most strains.