Hospital-Acquired Achromobacter Denitrificans Bacteremia: Case Report and Review of Literature

ABSTRACT

INTRODUCTION: Achromobacter denitrificans bacteremia is a rare condition and generally affects adults with multiple comorbidities and is usually a hospital acquired infection. We report a case of hospital acquired Achromobacter denitrificans bacteremia in a young female without any comorbidities, who presented to the hospital with severe viral pneumonia. DESCRIPTION A 33-year-old female was presented to the ER with increasing difficulty in breathing. On examination, she had labored breathing. Her oxygen saturation was 80% at room air. With oxygen support via face mask, her saturation increased to 83% with 15 L/min. Then non-invasive ventilation via BiPAP it improved to 90% and she was admitted to the medical ICU. Meanwhile, as per history from the husband, she had a cough and coryza for the past one week and was taking over the counter medications. Lab investigations at the time of admission reported WBC count as 7500/ cumm. She was tested negative for COVID-19. HR CT-scan showed bilateral ground glass opacities with bilateral patchy consolidations. For worsening hypoxia, she was intubated and placed on ventilator support (FiO260%). Her blood and urine culture reports were negative. The Liver function tests showed elevated SGOT/SGPT, suggesting acute hypoxic liver injury. Supportive care with IV steroids, and broad-spectrum antibiotics Pipercillin and Tazobactam was provided. In the second week, the patient's WBC started rising and peaked at 40,000/cumm on Day-10. Her condition worsened further despite being on 100% FiO2. The tracheal sample grew a colony of Acinetobacter Baumannii, while her blood cultures reported positive for A. Denitrificans sensitive to Pipercillin and Tazobactum. Chest X-Ray suggested features of acute respiratory distress syndrome with no signs of a cavitary lesion or abscess. Ultrasound abdomen and Echocardiography ruled out other sources of infection. Despite ventilatory support and medications, the patient deteriorated, and passed away after cardiorespiratory arrest. DISCUSSION: Achromobacter denitrificans cause opportunistic nosocomial infections, which has been recovered from ventilators, humidifiers, "sterile" saline, and IV fluids. A. denitrificans is associated with pneumonia, peritonitis, bacteremia, endocarditis, empyema, renal abscess, and pancreatic pseudocysts.