Volume 22, Number 8—August 2016
Research
Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014
, Pierre Cassier, Cédric Dananché, Monique Hulin, Olivier Dauwalder, Olivier Rouvière, Xavier Bertrand, Michel Perraud, Thomas Bénet, and Philippe Vanhems
Table 1
Clinical and microbiologic history of the 8 confirmed cases in the cluster of Achromobacter xylosoxidans and Ochrobactrum anthropi infections occurring after prostate biopsies, France, 2014*
| Characteristic | Patient ID |
|||||||
|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
| Date of biopsy | Aug 13 | Sep 12 | Sep 15 | Sep 30 | Sep 30 | Oct 3 | Oct 8 | Oct 10 |
| Patient age at onset, y | 66 | 60 | 59 | 62 | 65 | 54 | 68 | 69 |
| Days between biopsy and urinalysis | 13 | 2 | 3 | 10 | 3 | 6 | 8 | 7 |
| Highest fever level, °C | 39 | 39 | 38.5 | 38.6 | 39.1 | NR | 39 | 38.3 |
| Localized symptoms | No | Yes | No | Yes | No | NR | Yes | No |
| Hospitalization | Yes | Yes | Yes | Yes | Yes | No | No | No |
| Urine culture result | Negative | A. xyl | A. xyl | A. xyl | A. xyl | O. ant | A. xyl | O. ant |
| Blood culture result | O. ant | A. xyl | A. xyl | NA | A. xyl | NA | NA | NA |
| Curative antimicrobial treatment† | Yes | Yes | Yes | Yes | Yes | NR | Yes | No |
| Apyrexia without effective antimicrobial drug | Yes | No | Yes | No | Yes | NR | Yes | Yes |
| Immunosuppressive drugs | Yes | No | No | No | No | No | No | No |
*A. xyl, Achromobacter xylosoxidans; NA, cultures not requested; NR, not recorded; O. ant, Ochrobactrum anthropi.
†All patients received a single dose of 400 mg ofloxacin. Most received curative treatments: Patient 1, 2 g ceftriaxone/d intravenously for 3 d; then 200 mg ofloxacin/d orally for 10 d. Patient 2, ceftazidime, modalities unknown (treated outside the university hospital network). Patient 3, 2 g ceftriaxone 1× intravenously; then 200 mg ofloxacin 2×/d orally for 15 d. Patient 4, 2 g ceftriaxone/d intravenously for 3 d; then 1,200 mg amikacin 1× intravenously; then 800/160 mg co-trimoxazole 2×/d orally for 15 d. Patient 5, 2 g ceftriaxone/d intravenously for 3 d; then 4 g piperacillin 3×/d intravenously and 800/160 mg co-trimoxazole 3×/d orally for 4 d; then co-trimoxazole for 15 d. Patient 7, 1 g ceftriaxone/d intravenously for 2 d and 200 mg ofloxacin 2×/d orally for 21 d. Antibiogram of A. xylosoxidans for patients 2, 3, 4, 5, and 7 showed sensitivity to amoxicillin, ticarcillin, piperacillin (with or without β-lactamase inhibitors), ceftazidime, colistin, co-trimoxazole, and carbapenems and resistance to cefalotine, cefoxitine, cefotaxime, cefepime, aminoglycosides, quinolones, tigecyclin, fosfomycin, and rifampin. Antibiogram of O. anthropi for patient 1 showed sensitivity to carbapenems, aminoglycosides, ciprofloxacin, tigecyclin, rifampin, and co-trimoxazole and resistance to amoxicillin, ticarcillin, piperacillin (with or without β-lactamase inhibitors), cefalotine, cefoxitine, cefotaxime, ceftazidime, cefepime, aztreonam, norfloxacin, and fosfomycin. Antibiogram of O. anthropi for patient 8 was the same as for patient 1 except for sensitivity to norfloxacin. In hindsight, co-trimoxazole should probably have been used as first-line therapy.