| Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer (1989-2003). | |
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MedLine Citation:
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PMID: 15389476 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Achromobacter and Alcaligenes are emerging infectious gram-negative bacterial species that can affect immunosuppressed patients. The authors sought to determine the incidence and characteristics of bloodstream infections caused by these organisms in patients with underlying malignancies. METHODS: All consecutive episodes of hematogenous Achromobacter and Alcaligenes infections recorded from December 26, 1989, to July 27, 2003, were studied retrospectively. RESULTS: Fifty-two episodes occurred in 46 patients; 31 patients (67%) had hematologic malignancies, and 24 (52%) experienced neutropenia (< 500 cells/microL). Diabetes mellitus was present in 12 patients (26%), and high-dose corticosteroids were administered to 12 patients (26%). Seventeen of the 52 infectious episodes (33%) were nosocomial in origin, and 10 patients (22%) had sepsis syndrome. Achromobacter xylosoxidans was the most common cause of infection (47 of 52 episodes [94%]), followed by Ach. denitrificans (2 of 52 episodes [4%]) and Alcaligenes faecalis (1 of 52 episodes [2%]). Twenty-seven episodes (52%) were polymicrobial, and 3 patients (7%) had concurrent fungemia. Infected intravascular catheters were present in 13 of 52 cases (25%), pneumonia was encountered in 6 of 52 cases (12%), and urinary tract infections were present in 5 of 52 cases (10%). Most isolates exhibited in vitro susceptibility to carbapenems, antipseudomonal penicillins, and trimethoprim-sulfamethoxazole. Resistance to ciprofloxacin, levofloxacin, aminoglycosides, and monobactam was common. Seven deaths (15%) were attributable to Achromobacter species. Incidence rates for sepsis syndrome, multiorgan dysfunction (Acute Physiology and Chronic Health Evaluation [APACHE] II score > 16), and use of mechanical ventilation and pressor support were significantly higher in patients who died (P < 0.001). Logistic regression analysis revealed that sepsis syndrome and high APACHE II scores were predictors of increased 30-day mortality. CONCLUSIONS: Most infections caused by this group of nonfermentative gram-negative bacteria were attributable to Ach. xylosoxidans, and only one-third were acquired during hospitalization. The presence of sepsis syndrome has evolved as an independent predictor of poor outcome in patients with high-risk malignancies accompanied by Achromobacter bloodstream infections. |
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Authors:
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Gabriel Aisenberg; Kenneth V Rolston; Amar Safdar |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Cancer Volume: 101 ISSN: 0008-543X ISO Abbreviation: Cancer Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-10-27 Completed Date: 2004-11-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0374236 Medline TA: Cancer Country: United States |
Other Details:
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Languages: eng Pagination: 2134-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Achromobacter
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drug effects,
isolation & purification* Adult Aged Alcaligenes / drug effects, isolation & purification* Bacteremia / etiology* Female Gram-Negative Bacterial Infections / etiology* Humans Male Microbial Sensitivity Tests Middle Aged Neoplasms / complications* Retrospective Studies |
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