Achromobacter Xylosoxidans (ACHX) Infections (ACHX)

Achromobacter Xylosoxidans Infections : Epidemiology and Environmental Investigations

Data extraction from bacteriological laboratory of Martinique University hospital to determine the frequency and the distribution of nosocomial infections due to Achromobacter xylosoxidans (ACHX), an emerging multi-resistant environmental bacteria. The specific tropical environment and climatic conditions in Martinique may favor ACHX development and the investigators suppose that this new opportunistic pathogen can represent a danger for hospitalized patients. The aim of our study is to describe the most affected population and try to identify the main environmental sources of contamination.

Study Overview

• Status: Completed
• Conditions: Nosocomial Infection
• Intervention / Treatment: Other: descriptive retrospective epidemiological study

Detailed Description

In June 2016, a patient who developed a Staphylococcus aureus mediastinitis died of a superinfection by Achromobacter xylosoxidans. This germ is an hydrotelluric bacteria described as emergent and multi-resistant, involved in nosocomial infections. It is known to be responsible for severe nosocomial infections in immunocompromised individuals (endocarditis, bacteriemia, wound infections, pneumonia) associated with high morbidity and mortality but it is also able to infect immunocompetent patients. According to literature, it is capable of developing in antiseptic and disinfectant solutions due to the acquisition of resistance to these products. Moreover it has a great ability to form biofilms, resulting in major eradication difficulties, both on the environmental and clinical level.

Various environmental sources of contamination have been identified, including dental units water lines, dialysis water, nebulizers, reusable boxes of disinfectant wipes, siphons of patient's rooms, vials of heparin...

There is no evidence for the existence of a possible portage in humans, but ACHX has already been isolated from the intestine of a 3-month-old baby who has never received antibiotic treatment. On the other hand, this germ colonizes the respiratory system of patients with cystic fibrosis. The frequency of isolation in sputum of these patients is increasing for a decade for still unknown reasons. ACHX surgical site infections are rare and to our knowledge only two cases of ACHX mediastinitis have been reported in the literature to date, either because cases are indeed rare or because the high mortality rate restricts publications. The clinical case of our CHU caught our attention and the investigators contacted the laboratory of bacteriology to inquire about the existence of other cases of infection with this germ. The investigators have then seen that ACHX seems to evolve in low noise for more than 10 years in our hospital with about 10 cases of infection per year.

Also, the investigators wanted to learn more and propose a study articulated around two axes:

• An epidemiological axis, in which the investigators detail local epidemiology, calculate rates of impact and analyze their evolution over 10 years, identify the most affected units, identify the types of most common infections, identify a population at risk, study profiles of resistance of the isolated strains,
• An environmental axis with identification of potential sources after development of appropriate analytical methods.

The ultimate goal of this study is the protection of patients by the fight against ACHX nosocomial infections and other related germs, by preventive eradication methods of environmental sources once they have been identified. The investigators want to avoid a new fatal infection episode.

A research of ACHX natural reservoirs in Martinique is also conceivable subsequently, the hypothesis being that this germ, particularly greedy of heat and humidity, is very present in a tropical environment.

• Study Type: Observational
• Enrollment (Actual): 120

Contacts and Locations

Study Locations

• Martinique
  • Fort-de-France, Martinique, 97261
    • CHU de Martinique

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients hospitalized

Description

Inclusion Criteria:

• Patients hospitalized in Martinique University Hospital, Pierre Zobda Quitman site, from January 2006 to December 2016, with biological sample positive to ACHX

Exclusion Criteria:

• Patient hospitalized in another site…
• Patients hospitalized less than 48h before bacteriological analysis……

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Retrospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The incidence rate of Achromobacter xylosoxidans nosocomial infections	number of infections/ total number of patients hospitalized in our institution	january 2006 to december 2016

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The incidence density of Achromobacter xylosoxidans nosocomial infections	number of infections/ total number of days of hospitalization	january 2006 to december 2016
Mortality rate related to ACHX,	number of deaths at three months	january 2006 to december 2016

Collaborators and Investigators

• Sponsor: University Hospital Center of Martinique
• Investigators: Principal Investigator: Karine SANCHEZ, Pharma D, Martinique University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2016
• Primary Completion (Actual): May 1, 2017
• Study Completion (Actual): June 1, 2017

Study Registration Dates

• First Submitted: December 7, 2017
• First Submitted That Met QC Criteria: February 9, 2018
• First Posted (Actual): February 12, 2018

Study Record Updates

• Last Update Posted (Actual): July 24, 2019
• Last Update Submitted That Met QC Criteria: July 22, 2019
• Last Verified: February 1, 2018

More Information

Terms related to this study

• Keywords: antibiotic resistance; Epidemiology,; Achromobacter xylosoxidans,
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Iatrogenic Disease; Infections; Communicable Diseases; Cross Infection
• Other Study ID Numbers: 16/E/19

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No