From the Guidelines
Alcalingenes xylosoxidans in blood is a serious infection that requires immediate antibiotic treatment, typically with broad-spectrum antibiotics such as piperacillin-tazobactam, meropenem, or trimethoprim-sulfamethoxazole, as guided by susceptibility testing once available 1. The presence of Alcalingenes xylosoxidans in blood indicates a potentially life-threatening condition, particularly in immunocompromised patients or those with underlying lung conditions.
- Key considerations in managing this infection include:
- Identifying and addressing the infection source, which may involve removal of infected catheters or drainage of abscesses
- Administering intravenous antibiotics for 10-14 days, depending on the severity of the infection
- Guiding treatment by susceptibility testing to ensure the use of effective antibiotics
- Monitoring the patient's response to treatment and adjusting the antibiotic regimen as needed
- Repeating blood cultures to confirm clearance of the bacteremia
- It is essential to note that Alcalingenes xylosoxidans is naturally resistant to many antibiotics, making susceptibility testing crucial for effective treatment 1.
- The recommended antibiotics, such as piperacillin-tazobactam, meropenem, or trimethoprim-sulfamethoxazole, are typically administered intravenously for initial management, with potential transition to oral antibiotics for completing therapy if the infection responds well.
- Hospitalization is usually necessary for initial management, and follow-up care is essential to ensure complete resolution of the infection.
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 infections in high-risk patients 3, 4.