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Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit

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Abstract

Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term intravascular catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The catheter was removed in only one patient. The three patients in whom the catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous catheters and should be called into question. Patients with long-term intravascular catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without catheter removal.

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Acknowledgements

We thank Ma Paz Martín and Brendan Hayes for reviewing the English version of the manuscript.

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Authors and Affiliations

  1. Laboratory of Microbiology, Hospital General La Mancha Centro, Avenida de la Constitución no. 3, 13600, Alcázar de San Juan, Ciudad Real, Spain

    D. Tena & R. Carranza

  2. Department of Internal Medicine, Hospital General La Mancha Centro, Avenida de la Constitución no. 3,, 13600, Alcázar de San Juan, Ciudad Real, Spain

    J.R. Barberá

  3. Department of Bacteriology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain

    S. Valdezate & J.A. Sáez-Nieto

  4. Hemodialysis Unit, Hospital General La Mancha Centro, Avenida de la Constitución no. 3, 13600, Alcázar de San Juan, Ciudad Real, Spain

    J.M. Garrancho & M. Arranz

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  1. D. Tena
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  2. R. Carranza
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  3. J.R. Barberá
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  4. S. Valdezate
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  7. J.A. Sáez-Nieto
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Correspondence to D. Tena.

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Tena, D., Carranza, R., Barberá, J. et al. Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit. Eur J Clin Microbiol Infect Dis 24, 727–732 (2005). https://doi.org/10.1007/s10096-005-0028-4

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