Pediatric infective endocarditis caused by Achromobacter xylosoxidans: a case reportIntroduction: Infective endocarditis is uncommon in children but serious, especially in those with congenital heart disease or prior surgery. Achromobacter xylosoxidans is a rare Gram-negative cause, notable for its multidrug resistance and association with polymicrobial infections.
Case description: We present the case of a 9-year-old boy with a history of type 1 patent ductus arteriosus. He underwent surgical implantation of a duct with an integrated valve to replace the right ventricular outflow tract due to an aneurysm. Postoperatively, he developed a 39°C fever, managed with acetaminophen, and was discharged without further treatment. One week later, the fever recurred, prompting evaluation at Hospital B. Examination revealed a 4/6 systolic murmur with thrill at the left parasternal border. Suspected valve endocarditis was treated empirically with cefepime. Blood cultures later identified Achromobacter xylosoxidans sensitive to imipenem, and therapy was adjusted accordingly. No vegetations were seen on echocardiography. The patient was admitted to the intensive care unit under joint infectious disease and cardiology supervision and, after 22 days, was discharged in stable condition with continued outpatient follow-up.
Discussion: Pediatric infective endocarditis mostly occurs in children with congenital heart disease. Achromobacter xylosoxidans is rare outside cystic fibrosis or transplant cases and poses treatment challenges due to multidrug resistance. Effective agents include trimethoprim-sulfamethoxazole, ceftazidime, piperacillin, and carbapenems, though emerging resistance warrants close monitoring.
Conclusions: This case highlights the clinical relevance of Achromobacter xylosoxidans infections and the value of timely, multidisciplinary management, offering a useful reference for similar future cases.
Keywords:
Achromobacter xylosoxidans; congenital heart disease; endocarditis