Achromobacter Bacteremia in Immunocompromised Patients With Malignancy

Objectives: Achromobacter species are increasingly recognized as opportunistic pathogens in immunocompromised patients, yet contemporary data on Achromobacter bacteremia in patients with malignancy are limited. We describe a case series highlighting clinical presentations, antimicrobial resistance patterns, and outcomes in this high-risk population. Materials and Methods: We describe 3 cases of Achromobacter bacteremia in patients with hematologic malignancies at a tertiary cancer center. Clinical features, presumed sources of infection, antimicrobial susceptibilities, management strategies, and outcomes were reviewed. Results: The cases demonstrated heterogeneous routes of infection, including probable skin barrier translocation, delayed focal suppuration following bacteremia, and secondary bacteremia from necrotizing soft tissue infection. All patients were profoundly immunocompromised with prolonged neutropenia and prior antimicrobial exposure. Progressive antimicrobial resistance occurred in 2 cases, necessitating escalation to salvage therapies. Clinical outcomes were closely associated with the feasibility of source control and immune recovery; 1 patient recovered after surgical drainage and neutrophil reconstitution, whereas 2 experienced infection-related mortality. Conclusions: Achromobacter bacteremia represents a serious and potentially fatal infection in patients with malignancy. Management is challenged by antimicrobial resistance, recurrence, and host immunosuppression. Outcomes depend more on immune recovery and source control than antimicrobial therapy alone, underscoring the need for heightened vigilance and susceptibility-guided treatment strategies.