Catheter salvage with antibiotic lock therapy for central venous port infection due to Pseudoxanthomonas sp. in a child with hemophilia B.

BACKGROUND

Catheter-related bloodstream infections (CRBSIs) generally necessitate prompt catheter removal, which poses significant hemorrhagic risks in patients with hemophilia. Consequently, catheter salvage utilizing antibiotic lock therapy (ALT) serves as a critical adjunctive strategy. We describe an exceptionally rare case of CRBSI caused by Pseudoxanthomonas sp., an environmental Gram-negative bacillus, and its successful management.

CASE: A 4-year-old boy with severe hemophilia B developed persistent bacteremia originating from an implanted central venous access port. The pathogen was identified as Pseudoxanthomonas sp. utilizing matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene sequencing. Catheter removal was deemed high-risk due to the patient's underlying hemophilia B and associated risk of major bleeding. Therefore, a catheter salvage strategy was pursued through a combination of systemic antimicrobial therapy and ALT. The patient received systemic antibiotics, adapting through piperacillin/tazobactam, ceftazidime, and trimethoprim-sulfamethoxazole. ALT was administered concurrently, initially using a ceftazidime-heparin lock solution, and later transitioning to a ciprofloxacin-heparin lock following an episode of suspected drug fever. Despite initial persistent bacteremia, this dual approach effectively eradicated the intraluminal infection. The central venous port was successfully retained with no recurrence observed over four months post-therapy.

CONCLUSION

Systemic antimicrobial therapy combined with ALT can be an effective catheter-preserving strategy for high-risk patients with device-related infections caused by rare environmental non-fermenting Gram-negative organisms such as Pseudoxanthomonas sp.