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Achromobacter Xylosoxidans Pneumonia Secondary to Contaminated Home Nebulizer Use in a Patient with Non-Cystic Fibrosis Bronchiectasis
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A6708 - Achromobacter Xylosoxidans Pneumonia Secondary to Contaminated Home Nebulizer Use in a Patient with Non-Cystic Fibrosis Bronchiectasis
Author Block: C. J. Van Hook1, B. Warner1, A. Taylor1, M. Beer1, J. Gould1, E. J. McManus2; 1Longmont United Hospital, Longmont, CO, United States, 2St. Clare's Hospital, Denville, NJ, United States.
Introduction: Achromobacter xylosoxidans is a gram-negative bacillus that is an uncommon respiratory pathogen in patients with non-Cystic Fibrosis (CF) bronchiectasis. The organism is flagellated, motile, and can be found in various water supplies. Multi-drug resistance is common. Here we report a patient with non-CF bronchiectasis, community acquired Achromobacter xylosoxidans pneumonia, and isolation of the same organism from the reservoir of his home nebulizer unit.
Case report: A 77-year-old man with known non-CF bronchiectasis presented with fever and cough. Initial chest radiograph demonstrated a new right lower lobe infiltrate, as well as chronic changes of bronchiectasis. A bronchoalveolar lavage (BAL) specimen revealed Achromobacter xylosoxidans resistant to cephalosporins, quinilones, and aminoglycosides. The patient was treated with intravenous meropenem, and ultimately recovered to his normal baseline. The patient subsequently reported that prior to admission he had been regularly treating himself with twice-daily nebulized sterile saline. Cultures of a simple swab from the reservoir of his nebulizer grew Achromobacter xylosoxidans with a sensitivity panel identical to his BAL specimen.
Discussion: Achromobacter xylosoxidans is a rare cause of lower respiratory tract infections in patients with non-CF bronchiectasis. Multi-drug resistance is common and can make treatment challenging. To our knowledge, this is the first reported case of Achromobacter xylosoxidans pneumonia associated with a contaminated home nebulizer device. A history of environmental inhalation exposure to nebulized saline should heighten clinical suspicion for Achromobacter xylosoxidans in patients with underlying structural lung disease.
Author Block: C. J. Van Hook1, B. Warner1, A. Taylor1, M. Beer1, J. Gould1, E. J. McManus2; 1Longmont United Hospital, Longmont, CO, United States, 2St. Clare's Hospital, Denville, NJ, United States.
Introduction: Achromobacter xylosoxidans is a gram-negative bacillus that is an uncommon respiratory pathogen in patients with non-Cystic Fibrosis (CF) bronchiectasis. The organism is flagellated, motile, and can be found in various water supplies. Multi-drug resistance is common. Here we report a patient with non-CF bronchiectasis, community acquired Achromobacter xylosoxidans pneumonia, and isolation of the same organism from the reservoir of his home nebulizer unit.
Case report: A 77-year-old man with known non-CF bronchiectasis presented with fever and cough. Initial chest radiograph demonstrated a new right lower lobe infiltrate, as well as chronic changes of bronchiectasis. A bronchoalveolar lavage (BAL) specimen revealed Achromobacter xylosoxidans resistant to cephalosporins, quinilones, and aminoglycosides. The patient was treated with intravenous meropenem, and ultimately recovered to his normal baseline. The patient subsequently reported that prior to admission he had been regularly treating himself with twice-daily nebulized sterile saline. Cultures of a simple swab from the reservoir of his nebulizer grew Achromobacter xylosoxidans with a sensitivity panel identical to his BAL specimen.
Discussion: Achromobacter xylosoxidans is a rare cause of lower respiratory tract infections in patients with non-CF bronchiectasis. Multi-drug resistance is common and can make treatment challenging. To our knowledge, this is the first reported case of Achromobacter xylosoxidans pneumonia associated with a contaminated home nebulizer device. A history of environmental inhalation exposure to nebulized saline should heighten clinical suspicion for Achromobacter xylosoxidans in patients with underlying structural lung disease.
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