Achromobacter xylosoxidans is a rare cause of
bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four
hemodialysis patients with long-term intravascular
catheters. A culture from one
atomizer that contained diluted 2.5%
chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this
atomizer was discontinued. Five outbreak-related strains from the four patients and the
atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the
atomizer had identical PFGE patterns, confirming the
atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous
levofloxacin. The
catheter was removed in only one patient. The three patients in whom the
catheter was left in place were also treated with
antibiotic lock
therapy with
levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of
central venous catheter-related
bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with
chlorhexidine atomizers. The use of diluted
chlorhexidine via
atomizers can be dangerous for the care of venous
catheters and should be called into question. Patients with long-term intravascular
catheter-related
bacteremia due to this organism can be treated successfully with systemic antimicrobial
therapy in addition to
antibiotic lock
therapy without
catheter removal.