Achromobacter xylosoxidans

Question

Dear expert team,
are there any new insights on this germ or on the treatment possibilities or is it still Cayston® (aztreonam) that is used in the treatment of this germ?
Why is however then this germ not mentioned in the description of the drug, but only Pseudmonas?
At what time would you recommend to try a treatment at all? I mean, only if the lung function declines markedly or already before this?
And my last question - is it true that this germ is more in adult lungs, i.e. where the illness is at a more progredient stage? This is namely not the case in my daughter, at least not until now, in spite of this, since about 2 years she is colonized with it again and again!
Many thanks for your efforts.

Answer

Hello,
Achromobacter xylosoxidans is isolated more and more in CF patients. In spite of this, there is until now little knowledge about the course and about possible treatment strategies of this rare germ.
Achromobacter belongs to the gramnegative infectious agents. The transmission from patient to patient is rare. First infections and also chronic colonizations can be accompanied by acute pulmonary exacerbations. A clear correlation with a chronic respiratory worsening is until now not well documented. The individual course is very different, there are therefore courses with a clear worsening but however also courses that are relatively stable (that means without a strong loss of lung function). It is not clear, if the germ itself leads to a worsening or additionally leads to a worsening in case of an e.g. underlying Pseudomonas colonization.
The first detection is often from the age of 11 years on.
Achromobacter is regarded to be pathogenic for the lung and should probably be treated.
The germ is often multi-resistent, the treatment often difficult. The indication for a treatment has to be discussed in any case with the treating CF physician and is guided by the individual course. I would regard it as sensible to try an eradication in case of detection of the germ, for sure in case of worsening of the lung function a treatment should be initiated.
Antibiotics, that showed the greatest efficacy according to literature were: imipenem, meropenem, piperacillin and piperacillin-tazobactam. Combinations of antibiotics showed additional effects, here chloramphenicole plus minocycline or cimprofloxacin puls either imipenem or meropenem had been used. Up to now it is not clear, which regimen is the best, furthermore it is not clear if inhalative antibiotics are successful, even if colistin can suppress Achromobacter in vitro. Furthermore, there are hints, that Achromobacter seems to be sensible for Carbapenems. However I do not know any study data that prove that Cayston® (aztreonam) is also effective on Achromobacter. Cayston® is licensed in Austria from the age of 6 years on, the indication for Cayston® is the Pseudomonas infection.
Yours sincerely,
Dr. H. Ellemunter

27.05.2013

27.05.13 There is further information on this under Topics--> microbiology--> Alcaligenes / Achromobacter xylosoxidans (link: ecorn-cf.eu/index.php?id=65&L=0&tx_expertadvice_pi1[showitem]=36&tx_expertadvice_pi1[search]=).

Explicitely I want to cite a comment on Cayston® given by Prof. Döring (18.11.2010):
"Dear questioner,

Cayston® (substance: Aztreonam) is a novel antibiotic which could be used for treating such Achromobacter xylosoxidans infections when the antimicrobial resistance is increased towards other commonly used antibiotics such as aminoglycosides, polymyxins and ß-lactam antibiotics.

Best regards,
Prof. Gerd Döring"

D. d'Alquen