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Kidney Week

Abstract: FR-PO481

Achromobacter xylosoxidans: A Potentially Serious Occult Dialysis Catheter-Related Infection

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Rehman, Zahoor Ur, New York City Health and Hospitals Metropolitan, New York, New York, United States
  • Chaudhari, Ashok P., New York City Health and Hospitals Metropolitan, New York, New York, United States
  • Baumstein, Donald I., New York City Health and Hospitals Metropolitan, New York, New York, United States
  • Tahir, Muhammad Khalid, New York City Health and Hospitals Metropolitan, New York, New York, United States
Introduction

Hemodialysis(HD) catheter-related infection is one of the major causes of morbidity and mortality in HD patients. Achromobacter xylosoxidans (AX) is an aerobic, oxidase, and catalase-positive gram-negative bacillus that lives in various aqueous environments. There are reported cases of AX endocarditis, bacteremia, and an outbreak of AX bacteremia in a hemodialysis unit; however, after a thorough literature review, no case of isolated AX hemodialysis tunneled catheter infection was found. Therefore, we are reporting a case of an AX tunneled dialysis catheter infection causing sepsis.

Case Description

A 50-year-old African American man with a past medical history of end-stage-kidney-disease on hemodialysis for more than one year, hypertension, and hyperlipidemia, who had recently returned from Africa, presented with a low-grade fever, chills, and lethargy. While in Africa, the patient received hemodialysis via a right internal jugular permcath. He was treated with an unknown antibiotic in Africa for 14 days. However, his fever never resolved. On return to the United States, peripheral and tunneled catheter blood cultures revealed no growth, and no other focus of infection was identified. Chest x-ray and CT scan abdomen were unremarkable for any focus of infection. Respiratory PCRs were negative for viruses and atypical bacteria. As an inpatient, in spite of receiving ceftazidime and vancomycin for more than two weeks, he was still febrile despite repeat negative peripheral blood and central line cultures; therefore, a decision was made to remove the tunneled catheter and send the catheter tip for culture, which showed growth of achromobacter xylosoxidans(too numerous to count). It was resistant to a variety of antibiotics; however, sensitive to meropenem. He was treated with meropenem, and his fever resolved following the removal of the tunneled catheter.

Discussion

Achromobacter xylosoxidans is an aerobic, oxidase, and catalase-positive gram-negative bacillus living in various aqueous environments with low virulence. It can cause occult dialysis catheter-related infections and be challenging to identify and treat. Strains of AX are highly resistant to various antibiotics and should be treated with appropriate antibiotics, usually sensitive to antipseudomonal penicillin, levofloxacin, meropenem, and trimethoprim-sulfamethoxazole.