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Volume 22, Number 8—August 2016
Research

Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014

Skerdi HaviariComments to Author , Pierre Cassier, Cédric Dananché, Monique Hulin, Olivier Dauwalder, Olivier Rouvière, Xavier Bertrand, Michel Perraud, Thomas Bénet, and Philippe Vanhems
Author affiliations: Hospices Civils de Lyon, Lyon, France (S. Haviari, P. Cassier, C. Dananché, M. Hulin, O. Dauwalder, O. Rouvière, M. Perraud, T. Bénet, P. Vanhems); Université Claude Bernard, Lyon (S. Haviari, P. Cassier, C. Dananché, O. Dauwalder, O. Rouvière, M. Perraud, T. Bénet, P. Vanhems); Centre International de Recherche en Infectiologie, Lyon (P. Cassier, O. Dauwalder, T. Bénet, P. Vanhems); Centre Hospitalier Régional Universitaire de Besançon, Besançon, France (X. Bertrand); Laboratoire des Pathogènes Émergents–Fondation Mérieux, Lyon (T. Bénet, P. Vanhems)

Main Article

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.

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Page created: July 15, 2016
Page updated: July 15, 2016
Page reviewed: July 15, 2016
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