Xylophone Infections: Almost a Literal Ear Worm

Infectious xylophones? Am I talking about Gone Daddy Gone by the Violent Femmes? Maybe. Listen at your peril. But alas no. I’m talking about Achromobacter xylosoxidans which I may now refer to a A. Xylophone because you don’t need to hear me mumble my words more than I already do. So what is this infectious musical instrument? 

The patient, a middle age female with an abscess on the scalp that had grown over the last week or so and become progressively more sore and tender. However, this was only the latest iteration in a years long cycle. A culture swab was taken and came back with P. Acnes and A. Xylophone. I might have geeked out at the first, I had just listened to a Gobbet O’ Pus about a P. Acnes joint infection. But the xylophone? What the h, e, double hockey sticks? I said hello to my friend the Googles to see what was up. 

The xylophone is most often isolated from 60s-70s rock music. Oh wrong xylophone. It is most often isolated from the airways of those with cystic fibrosis. The patient didn’t have CF, at least as far as the patient was aware. Additionally, the mostly cause pneumonia (logical due to CF) and bacteremia in patients with implanted medical devices and history of diabetes, chronic heart failure, and hospitalizations. No, no, no, and no. 

Her primary had placed her on amoxicilin/clavulonic acid which evidently did zero to help her out. Why she was kept on it I do not know. The provider placed her on doxycycline 100mg BID but she never came back for follow up. I had never heard of this bug, which is not shocking, and some digging led me to find that it can be a real pain to treat. It has a lot of intrinsic resistance factors and one study from 2018 looked at a small sample of patients with A. Xylophone. It found that of the 13 samples 38% were resistant to Amikacin, 53.8% to cefepime, 36% to ciprofloxacin, 70% to gentamicin, and 43% to TMP/SMX. That's not even all of them. Another bit I found is that A. Xylophone is resistant to azithromycin, a drug used in CF patients, who are also the primary host of the said xylophone. Just an interesting tidbit if you run across a CF pulmonary infection that doesn't get better with azithromycin. 

I really cannot wait to finish my NCLEX-RN and be able to dive even deeper. Right now I'm splitting my brain between studying and this stuff. Plus, when I get to my new job I can bug the hell out of the ID doc. That is all I have to say. Thank goodness, I know your eyes were starting to bleed after reading that. 


References

Achromobacter Infections and Treatment Options by Isler et al. in the journal Antimicrobial Agents and Chemotherapy from October 2020. 

Achromobacter xylosoxidans bacteremia: clinical and microbiological features in a 10-year case series by Barragan et al. in the Official Journal of the Spanish Society of Chemotherapy 2018. 

Clinical and laboratory characteristics of Achromobacter xylosoxidans infection by Igra-Siegman, Chmel, & Cobbs in the Journal of Clinical Microbiology 1980.

Clinical features, antibiotic susceptibility profiles, and outcomes of infectious keratitis caused by Achromobacter xylosoxidans by Spieler et al. in Cornea 2016. 

Image of the xylophone from the Science Direct page on Achromobacter.

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