Extensively drug-resistant Alcaligenes faecalis infection

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RESEARCH ARTICLE

Open Access

Extensively drug-resistant Alcaligenes faecalis infection Chienhsiu Huang

Abstract Background: Alcaligenes faecalis is usually causes opportunistic infections in humans. Alcaligenes faecalis infection is often difficult to treat due to its increased resistance to several antibiotics. The results from a clinical study of patients with Alcaligenes faecalis infection may help improve patients’ clinical care. Methods: We conducted a retrospective analysis of all patients presenting with Alcaligenes faecalis infection from January 2014 to December 2019. The medical records of all patients were reviewed for demographic information, clinical symptoms and signs, comorbidities, use of intravenous antibiotics within the past three months, bacterial culture, antibiotics sensitivity test, and clinical outcomes. Results: Sixty-one cases of Alcaligenes faecalis infection were seen during the study period, including 25 cases of cystitis, nine cases of diabetic foot infection, eight cases of pneumonia, seven cases of acute pyelonephritis, three cases of bacteremia, and nine cases of infection at specific sites. Thirty-seven patients (60.7%) had a history of receiving intravenous antibiotics within three months of the diagnosis. Fifty-one (83.6%) cases were mixed with other bacterial infections. Extensively drug-resistant infections have been reported since 2018. The best sensitivity rate to Alcaligenes faecalis was 66.7% for three antibiotics (imipenem, meropenem, and ceftazidime) in 2019. Two antibiotics (ciprofloxacin and piperacillin/tazobactam) sensitivity rates to A. faecalis were less than 50%. Conclusions: The most frequent Alcaligenes faecalis infection sites, in order, are the bloodstream, urinary tract, skin and soft tissue, and middle ear. The susceptibility rate of Alcaligenes faecalis to commonly used antibiotics is decreasing. Extensively drug-resistant Alcaligenes faecalis infections have emerged. Keywords: Alcaligenes faecalis infection, Extensively drug-resistant

Introduction Alcaligenes faecalis (A. faecalis) is a Gram-negative, obligate aerobic, oxidase-positive, catalase-positive, and nonfermenting bacterium. It is commonly found in soil, water, and in hospital settings, such as in respirators, hemodialysis systems, and intravenous solutions [1, 2]. It is a potentially emerging pathogen and usually causes opportunistic infections in humans. The organism has been isolated from a range of clinical materials, such as urine, blood, wound discharge, stool, cerebrospinal fluid, Correspondence: [email protected]; [email protected] Department of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, NO. 2, Min-Sheng Road. Dalin Town, Chiayi County, Taiwan

and respiratory secretions [3–6]. A. faecalis has been associated with endocarditis, bacteremia, meningitis, endophthalmitis, skin and soft tissue infections, urinary tract infections, otitis media, peritonitis, and pneumonia [1, 2, 7–28]. A. faecalis infection is often dif