Intra-abdominal infections caused by Achromobacter xylosoxidans: a systematic review

Achromobacter xylosoxidans is an emerging cause of intra-abdominal infections, typically after healthcare exposure or in patients with indwelling devices. Intrinsic multidrug resistance and biofilm formation impede empiric therapy and often necessitate source control (catheter/stent exchange or removal). Because guidance is scattered across case reports, we systematically reviewed published episodes to quantify healthcare exposure, antimicrobial selections and susceptibilities, use of source control, and outcomes.

In accordance with PRISMA 2020, we searched PubMed, Scopus, and Google Scholar from inception to 10 October 2025 for English-language case reports/series, correspondence, and letters. We extracted demographics, presentation, exposures, microbiology, treatment, source control, and outcomes.

We included 32 episodes from 29 articles. The mean age was 53.9 years, and 17/32 (53.1%) were female. Healthcare exposure occurred in 30/32 (93.8%) patients, and device- or procedure-related involvement occurred in 22/32 (68.8%) patients. Abdominal pain was reported in 20/32 (62.5%) patients. All cases were culture-confirmed. Source control was performed in 12/32 (37.5%) patients. Clinical improvement occurred in 24/32 (75.0%); relapse occurred in 8/32 (25.0%), with most relapses device-associated; and death occurred in 6/32 (18.8%) cases.

A. xylosoxidans intra-abdominal infections are uncommon but largely healthcare-associated and often device-related. Because standard empiric regimens frequently lack activity against A. xylosoxidans, clinicians should suspect it when a nonfermenting Gram-negative rod is reported or when patients fail to improve on initial therapy and promptly initiate susceptibility-guided antibiotics with timely source control to reduce relapse and mortality. Standardized reporting of susceptibilities, device management, and outcomes is needed to refine the regimen and duration choices.