Alcaligenes xylosoxidans cholecystitis and meningitis acquired during bathing procedures in a burn unit: a case...

The information in this article was presented at the 37th Annual Meeting of the Japan Society of Burn, Nagoya, Japan, June 7-8, 2008. Alcaligenes xylosoxidans, a nonfermentative, Gram-negative rod often found in aqueous environments, has been isolated from respirators, incubators, and disinfectant solutions in the hospital environment. It is known to cause disease in immunocompromised (eg, burn) patients and represents a cross-contamination risk related to wound care. In the authors' burn unit, two patients, admitted with deep dermal burns during a 1-month time period, acquired serious A. xylosoxidans infections. The first involved A. xylosoxidans-associated cholecystitis in an adult with 32% total body surface area (TBSA) burns and the second involved A. xylosoxidans meningitis in an adult with 30% TBSA burns. Both patients received hydrotherapy (bathing) in the same bathing tub, one patient after the other. Culture from environmental sources isolated A. xylosoxidans from the bathing mattress. Bacterial analysis of the isolates, including antimicrobial susceptibility testing and pulsed-field gel electrophoresis, suggested the patients had been infected by the same strain - ie, cross-contaminated - probably during treatment of their burns. The isolated strains were resistant not only to broad-spectrum penicillins and cephalosporins, but also to imipenem, to which past A. xylosoxidans strains have been susceptible. These findings underscore the need for strict infection control to prevent cross-contamination and disease outbreak.