title: Hospital-acquired pneumonia due to Achromobacter xylosoxidans in the elderly: A single-center retrospective study in Beijing.
abstract: BACKGROUND
  Achromobacter xylosoxidans has been reported in several countries; however, hospital-acquired pneumonia (HAP) due to this organism in elderly patients in China remains rare.
  
  
  METHODS
  HAP due to Achromobacter xylosoxidans identified at the General Hospital of the People's Liberation Army in Beijing from January 2008 to October 2011 was studied. Detailed clinical manifestations were collected. To study the clinical risk factors for the imipenem-resistant strain, patients were divided into two groups: imipenem-resistant (21 cases) and imipenem-nonresistant (20 cases). Univariate and multivariate logistic regression were used.
  
  
  RESULTS
  All patients were > 75 years of age, and 92.7% (38/41) were male. Nine patients died 30 days after infection. The mean acute physiology and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) were 23.66 ± 7.71 and 6.93 ± 2.47, respectively. Almost all strains were resistant to aminoglycosides. However, the strains showed significant sensitivity to minocycline (MIN), piperacillin-tazobactam (PTZ), and cefoperazone-sulbactam (SCF). Compared with the imipenem-nonresistant group, more patients with imipenem-resistant infection had the following characteristics: use of an intubation, use of a proton-pump inhibitor (PPI), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CHD). Among the four risk factors, COPD and CHD remained independent risk factors in the multivariate analysis.
  
  
  CONCLUSIONS
  HAP due to Achromobacter xylosoxidans occurred in severely ill elderly patients with a long-term indwelling catheter and many underlying diseases. Effective treatment of imipenem-resistant organisms is challenging. SCF, PTZ, and MIN may be useful for imipenem-resistant Achromobacter xylosoxidans.
authors.affiliation: Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, China. liuchao3619@163.com.
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.forename: Weifeng
authors.initials: W
authors.lastname: Yan
authors.forename: Yi
authors.initials: Y
authors.lastname: Jin
authors.forename: Fei
authors.initials: F
authors.lastname: Pan
authors.forename: Xiangqun
authors.initials: X
authors.lastname: Fang
authors.forename: Long
authors.initials: L
authors.lastname: Qin
authors.forename: Changting
authors.initials: C
authors.lastname: Liu
mesh_terms: D042441:Achromobacter denitrificans / Q000302:isolation & purification*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000068476:Beijing / Q000453:epidemiology; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D006769:Hospitals, General; D006787:Hospitals, Veterans; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D008297:Male; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem