Post-ERCP bacteremia caused by Alcaligenes xylosoxidans in a patient with pancreas cancer
© Yilmaz et al. 2006
Received: 29 May 2006
Accepted: 01 September 2006
Published: 01 September 2006
Alcaligenes xylosoxidans is an aerobic, motile, oxidase and catalase positive, nonfermentative Gram negative bacillus. This bacterium has been isolated from intestine of humans and from various hospital or environmental water sources. A.xylosoxidans is both waterborne and results from the poor-hygienic conditions healthcare workers are in. In this case report, the bacteremia which appeared in a patient with pancreas cancer after ERCP was described.
Alcaligenes xylosoxidans is a rare cause of bacteremia. This organism, also known as Achromobacter xylosoxidans, is an aerobic, motile, oxidase and catalase positive, nonfermentative Gram negative bacillus. A.xylosoxidans is opportunistic and usually affects severely immunocompromised patients such as those with neutropenia and those with a malignant or cardiovascular disease [3, 4]. This microorganism has been isolated from blood, cerebrospinal fluid, stool, urine, sputum, peritoneal fluid, skin, ear discharge, wounds, abscesses, bone, joints, endocardium and central venous catheters [3–8].
In the present report is described a case with bacteremia due to A.xylosoxidans post-ERCP in patient of pancreas cancer.
Key characteristics of A.xylosoxidans
NO3 to NO2
In-vitro susceptibility profile of A.xylosoxidans
Obstruction of the bile duct by stones or tumor can facilitate bacterial colonization; subsequent instrumentation has resulted in bacteremia rates mean 18.0%. [9, 10]. The highest bacteremia rates are seen in therapeutic ERCP. In purely diagnostic ERCP, the bacteremic rate is lower at 8% [10, 11]. The microorganism most responsible for post-ERCP bacteremia is Escherichia coli  . A.xylosoxidans is a rare but important cause of bacteremia in immunocompromised patients. The gastrointestinal tract has been suggested as a source for A.xylosoxidans bacteremia in patients with cancer . Our case report is the first one associated with A.xylosoxidans that causes post-ERCP bacteremia.
A.xylosoxidans has been isolated from intestine of humans and from various hospital or environmental water sources . The natural sources of A.xylosoxidans infections are well water, tap water, swimming pools, and moist soil [14, 15]. A.xylosoxidans causing nosocomial infections is waterborne (disinfectant solutions, intravenous fluids, dialysis solutions) and results from the fact that healthcare workers do not use gloves [13, 15, 16]. In our case, peripheral factors wereanalysed as a source of infection but any environmental contamination couldn't be indicated. Thatthe patient had symptoms of infection one day after ERCP made us think that the infection was from the intestines.
A.xylosoxidans is a weakly virulent microorganism. In general, there is an underlying dissease in patients. A.xylosoxidans have been reported in patients with cancer, neutropenia, bone marrow or liver transplant, renal failure, cystic fibrosis, HIV infection, IgM deficiency, neonates [4–6, 15, 17] .
This report showed that A.xylosoxidans was sensitive to cefoperazone/sulbactam, ciprofloxacin, imipenem, piperacillin/tazobactam and trimethoprim/sulfametoxazole and resistant to the third generation cephalosporins with the exception of the cefoperazone/sulbactam, amikacin and tobramycin. In previous studies, it was reported that A.xylosoxidans was resistant to most of the antimicrobial agents [15, 17, 18].
In summary, the post-ERCP bacteremia caused by A.xylosoxidans was presented in a 70-year-old man with pancreas cancer. The case report may help to redefine the role of A.xylosoxidans in post ERCP infections. The association of A.xylosoxidans with bacteremia further extends the clinical spectrum of this rare pathogen. This unusual case highlights that an effective antimicrobial therapy based on an immediate microbiologycal analysis may be life-saving in patients presenting a severe complication of ERCP.
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