From the Guidelines
Alcalingenes xylosoxidans in blood is a serious infection that requires prompt treatment with broad-spectrum antibiotics, such as piperacillin-tazobactam or meropenem, due to its intrinsic resistance to many antibiotics, as seen in patients with bronchiectasis who may be colonized by this bacterium 1. When this gram-negative bacterium is detected in blood cultures, treatment typically involves adjusting the initial empiric therapy based on susceptibility testing results. The treatment duration is usually 10-14 days for uncomplicated bacteremia or longer (4-6 weeks) if there are complications like endocarditis or deep-seated infections.
- Key considerations in managing Alcalingenes xylosoxidans infections include:
- Identifying the source of infection, which may involve removal of infected catheters or drainage of abscesses
- Addressing underlying conditions, such as bronchiectasis, that may be contributing to the infection
- Monitoring for antibiotic resistance and adjusting treatment accordingly
- Providing supportive care to manage symptoms and prevent complications The infection carries significant mortality risk, particularly in immunocompromised hosts, making rapid identification and appropriate antibiotic therapy essential for successful treatment, as highlighted in the management of adult lower respiratory tract infections 1.
From the Research
Alcalingenes xylosoxide in Blood
- Alcaligenes xylosoxidans is a gram-negative bacillus that can cause opportunistic infections, particularly in immunocompromised patients, the elderly, and those with chronic disorders or premature infants 2, 3, 4.
- The bacterium can lead to bacteremia, which is often acquired nosocomially, and can be resistant to multiple antibiotics 2, 3, 5.
- Clinical features of Alcaligenes xylosoxidans bacteremia include primary bacteremia, catheter-associated bacteremia, surgical wound infection, pneumonia, urinary tract infection, and empyema 3.
- Treatment with imipenem has been shown to be effective in eliminating the bacteremia, and removal of central venous catheter systems is also recommended 2, 4, 5.
- The susceptibility of Alcaligenes xylosoxidans to antibiotics can vary, but meropenem has been shown to have good in vitro activity against the bacterium 5.
- Extensively drug-resistant Alcaligenes faecalis infections have been reported, highlighting the need for careful antibiotic selection and monitoring of resistance patterns 6.
Risk Factors and Patient Characteristics
- Immunocompromised patients, such as those with acute lymphoblastic leukemia, are at higher risk of developing Alcaligenes xylosoxidans bacteremia 2, 4.
- Patients with underlying diseases, such as solid organ cancer and heart failure, are also at increased risk 5.
- The presence of a central venous catheter and previous antibiotic therapy can also increase the risk of developing Alcaligenes xylosoxidans bacteremia 3, 5.
Treatment and Outcomes
- Treatment with carbapenem-based therapy, such as imipenem or meropenem, may be appropriate in most cases of Alcaligenes xylosoxidans bacteremia 5.
- The case-fatality rate for Alcaligenes xylosoxidans bacteremia can be high, particularly in patients with primary bacteremia or prior chemotherapy 5.
- Strict infection control measures are necessary to prevent the spread of Alcaligenes xylosoxidans in healthcare settings 3, 4.