From the Guidelines
Achromobacter infection management typically involves antimicrobial therapy, with the choice of antibiotic dependent on susceptibility testing 1.
Key Considerations
- The evidence provided is for Acinetobacter species, not Achromobacter, but given the similarity in names and the lack of specific guidelines for Achromobacter, we can extrapolate some general principles from the provided evidence.
- For Achromobacter infections, antimicrobial susceptibility testing is crucial to guide therapy, as these species can exhibit resistance to multiple antibiotics 1.
- Carbapenems or ampicillin/sulbactam may be considered if the isolate is susceptible to these agents, although the evidence is based on Acinetobacter species 1.
- In cases where the isolate is sensitive only to polymyxins, intravenous polymyxin (colistin or polymyxin B) may be recommended, with adjunctive inhaled colistin considered in certain cases 1.
Treatment Approach
- The treatment approach should be individualized based on the severity of the infection, patient comorbidities, and antimicrobial susceptibility testing results.
- Intravenous antibiotics such as piperacillin-tazobactam or ceftazidime may be used for more severe infections, although the specific choice of antibiotic should be guided by susceptibility testing.
- Inhaled antibiotics such as tobramycin or colistin may be considered in cases of cystic fibrosis or immunocompromised patients, in addition to intravenous therapy.
- The duration of therapy should be tailored to the individual patient, but typically ranges from 7-21 days, depending on the severity of the infection and clinical response.
From the Research
Management of Achromobacter Infection
The management of Achromobacter infection is challenging due to its multidrug-resistant nature. Several studies have investigated the antimicrobial susceptibility of Achromobacter species and potential treatment options.
- A study published in 2020 2 found that piperacillin-tazobactam and co-trimoxazole were the most active antimicrobials against Achromobacter species, with susceptibility rates of 70.27% and 69.72%, respectively.
- Another study published in 2021 3 found that imipenem was the most active antimicrobial agent, with a susceptibility rate of 70%, followed by trimethoprim-sulfamethoxazole, piperacillin, and tigecycline.
- The use of new antibiotics, such as cefiderocol, has also been investigated as a potential treatment option for Achromobacter infections 3, 4.
- A review of published cases of non-cystic fibrosis achromobacterial lung infections found that extended-spectrum penicillins and cephalosporins, such as ticarcillin, piperacillin, and cefoperazone, were effective in treating these infections 5.
- A case report published in 2015 6 described the successful treatment of multiresistant Achromobacter xylosoxidans bacteremia in a child with acute myeloid leukemia using tigecycline and piperacillin-tazobactam.
Antimicrobial Susceptibility Patterns
The antimicrobial susceptibility patterns of Achromobacter species vary, with some species being more resistant to certain antibiotics than others.
- A study published in 2020 2 found that Achromobacter xylosoxidans was the most prevalent species, and that it was responsible for persistent infection in 18 out of 28 patients.
- Another study published in 2021 3 found that the susceptibility of Achromobacter isolates to different antibiotics varied, with some isolates being susceptible to certain antibiotics while others were resistant.
- The use of antimicrobial combination testing has been suggested as a way to identify the most effective treatment options for Achromobacter infections 2.
Treatment Options
The treatment of Achromobacter infections requires a comprehensive approach, taking into account the antimicrobial susceptibility patterns of the infecting organism and the clinical condition of the patient.
- Combination therapy using multiple antibiotics, such as piperacillin-tazobactam and co-trimoxazole, may be effective in treating Achromobacter infections 2, 6.
- The use of new antibiotics, such as cefiderocol, may also be considered as a treatment option for Achromobacter infections 3, 4.
- Supportive care, such as management of underlying conditions and prevention of further infections, is also important in the treatment of Achromobacter infections.