Cath Lab Digest

Login to Download
PDF version

Index: Ostomy Wound Manage. 2008;54(12):48-53.

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.

KEYWORDS: burn wounds, Alcaligenes xylosoxidans, bathing, burns unit, cross-contamination

   In the hospital environment, Alcaligenes xylosoxidans has been isolated from respirators, incubators, and disinfectant solutions.^1,2 A. xylosoxidans infection is thought to occur mostly in immunocompromised patients and those with severe underlying disease conditions. ^3,4 The majority of A. xylosoxidans strains are multidrug-resistant; thus, strict infection control is required to prevent spread of disease. ^3,4 Two cases (one unusual because of the rarity of A. xylosoxidans-related cholecystitis) occurred within a 1-month period in patients who had sustained severe burns and had been treated in the burn unit of the authors’ facility.

Case Reports

   Case 1. Mr. B, a 78-year-old man, sustained flame burns when his trousers accidentally caught fire in May 2007. He was immediately taken to the authors’ burn unit. On initial examination, it was noted that Mr. B had sustained deep burn (DB) to both lower legs, comprising 8% of the total body surface area (BSA); deep dermal burn (DDB) to both thighs, comprising 14% of the total BSA; and superficial dermal burn (SDB) to both forearms and the face, comprising 10% of the total BSA (see Figure 1). A decompression incision was made in both lower legs. The next day, all DB and DDB tissue was surgically removed from the legs and skin grafting was performed. Seven days after surgery, Mr. B underwent hydrotherapy in a hospital bathing tub — 10 days later, he developed a high fever and severe infection in both lower legs. Below-the-knee amputation was performed emergently for both legs due to life-threatening sepsis. Mr. B’s general condition improved over the next 2 weeks and he underwent bathing treatment every other day. Forty days after the injury, A. xylosoxidans was isolated from the residual wound, prompting immediate culture of environmental surfaces. A. xylosoxidans was isolated from the bathing mattress (see Figure 2).