{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:49:15Z","timestamp":1790290155733,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The prevalence of Achromobacter xylosoxidans is increasing in people with Cystic Fibrosis (pwCF), yet its clinical pathogenicity remains controversial. The objective of this study was to chart the longitudinal prevalence and examine clinical associations before and after infection. Methods: This observational, retrospective study was conducted at a single CF center over a 14-year period. Data were collated from patient charts and clinic databases. Patients with Achromobacter sputum cultures were compared to those without the bacterium and analyzed according to whether they had single, intermittent, or chronic infections. Results: During the study period, an annual average of 124 pwCF were followed up at our clinic, with a median age of 13.6 years (IQR = 7.6\u201327.7). The Achromobacter detection rate increased from 0 to 6.1%. Twenty-three percent (29\/124) of patients had at least one positive culture. The median age at acquisition was 17 years (IQR = 14.5\u201333). At the time of acquisition, the median FEV1 was 81% (IQR = 46\u201394), compared to 90% (IQR = 72\u201399) for patients without Achromobacter, p &lt; 0.001. Patients with Achromobacter tended to demonstrate more chronic Pseudomonas (55% vs. 27%, p = 0.06) and pancreatic insufficiency (66% vs. 47%, p = 0.07). At two years post-acquisition, the median FEV1 for patients with intermittent and chronically infected decreased by 11.5% (IQR = \u22123.75\u20137.5), compared to 1.5% (IQR = \u22122.5\u201312.5) for those with a single positive culture, p = 0.03. Similarly, pulmonary exacerbations per year became more frequent post-acquisition in intermittent and chronically infected patients: Median (range) 2.5 (0\u20138) pre-, versus 3.0 (0\u20139) post-acquisition, p = 0.036. Conclusions: Chronic and intermittent infection with Achromobacter were associated with accelerated lung function decline and increased exacerbation frequency. Larger prospective studies are needed to confirm these findings and examine the effect of eradication on the clinical course.<\/jats:p>","DOI":"10.3390\/jcm14072437","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T04:33:43Z","timestamp":1743654823000},"page":"2437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Association of Achromobacter xylosoxidans Airway Infection with Disease Severity in Cystic Fibrosis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7259-4539","authenticated-orcid":false,"given":"Ophir","family":"Bar-On","sequence":"first","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6683-0264","authenticated-orcid":false,"given":"Meir","family":"Mei-Zahav","sequence":"additional","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6772-5784","authenticated-orcid":false,"given":"Hagit","family":"Levine","sequence":"additional","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda","family":"Mussaffi","sequence":"additional","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Blau","sequence":"additional","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haim","family":"Ben Zvi","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"},{"name":"Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4165-0144","authenticated-orcid":false,"given":"Dario","family":"Prais","sequence":"additional","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-8212","authenticated-orcid":false,"given":"Patrick","family":"Stafler","sequence":"additional","affiliation":[{"name":"Graub CF Center, Pulmonary Institute, Schneider Children\u2019s Medical Center of Israel, Petach Tikva 4920235, Israel"},{"name":"School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/MCP.0b013e32835f1afc","article-title":"Respiratory bacterial infections in cystic fibrosis","volume":"19","author":"Ciofu","year":"2013","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jcf.2015.03.012","article-title":"Emerging bacterial pathogens and changing concepts of bacterial pathogenesis in cystic fibrosis","volume":"14","author":"Parkins","year":"2015","journal-title":"J. Cyst. Fibros."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/ppul.10143","article-title":"Alcaligenes infection in cystic fibrosis","volume":"34","author":"Tan","year":"2002","journal-title":"Pediatr. Pulmonol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jcf.2006.05.011","article-title":"Achromobacter xylosoxidans in cystic fibrosis: Prevalence and clinical relevance","volume":"6","author":"Schelstraete","year":"2007","journal-title":"J. Cyst. Fibros."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Firmida, M.C., Pereira, R.H., Silva, E.A., Marques, E.A., and Lopes, A.J. (2016). Clinical impact of Achromobacter xylosoxidans colonization\/infection in patients with cystic fibrosis. Braz. J. Med. Biol. Res., 49.","DOI":"10.1590\/1414-431X20155097"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/j.1600-0463.2008.00995.x","article-title":"Achromobacter xylosoxidans respiratory tract infections in cystic fibrosis patients","volume":"116","author":"Raso","year":"2008","journal-title":"Apmis"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Zolin, A., Bossi, A., Cirilli, N., Kashirskaya, N., and Padoan, R. (2018). Cystic Fibrosis Mortality in Childhood. Data from European Cystic Fibrosis Society Patient Registry. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15092020"},{"key":"ref_8","unstructured":"Foundation, C.F. (2025, March 30). Patient Registry Annual Data Report. Cyst Fibros Found Patient Regist. Available online: https:\/\/www.cff.org\/sites\/default\/files\/2021-10\/2019-Annual-Report.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1513\/AnnalsATS.201406-288FR","article-title":"Achromobacter respiratory infections","volume":"12","author":"Swenson","year":"2015","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3942","DOI":"10.1128\/JCM.39.11.3942-3945.2001","article-title":"Identification and antimicrobial susceptibility of Alcaligenes xylosoxidans isolated from patients with cystic fibrosis","volume":"39","author":"Saiman","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1128\/JCM.00014-09","article-title":"Low rates of Pseudomonas aeruginosa misidentification in isolates from cystic fibrosis patients","volume":"47","author":"Kidd","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Menetrey, Q., Sorlin, P., Jumas-Bilak, E., Chiron, R., Dupont, C., and Marchandin, H. (2021). Achromobacter xylosoxidans and Stenotrophomonas maltophilia: Emerging Pathogens Well-Armed for Life in the Cystic Fibrosis Patients\u2019 Lung. Genes, 12.","DOI":"10.3390\/genes12050610"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Billiot, C.E., McDaniel, M.S., Lindgren, N.R., and Swords, W.E. (2023). Pathogenesis of Achromobacter xylosoxidans respiratory infections: Colonization and persistence of airway epithelia and differential gene expression in synthetic cystic fibrosis sputum medium. bioRxiv, Update in: Infect. Immun. 2023, 91, e0041623. https:\/\/doi.org\/10.1128\/iai.00416-23.","DOI":"10.1101\/2023.04.04.535650"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s10096-011-1182-5","article-title":"Achromobacter xylosoxidans respiratory tract infection in cystic fibrosis patients","volume":"30","author":"Lambiase","year":"2011","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1099\/jmm.0.000763","article-title":"Effect of respiratory Achromobacter spp. infection on pulmonary function in patients with cystic fibrosis","volume":"67","author":"Recio","year":"2018","journal-title":"J. Med. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jcf.2022.11.001","article-title":"Clinical outcomes associated with Achromobacter species infection in people with cystic fibrosis","volume":"22","author":"Kerem","year":"2023","journal-title":"J. Cyst. Fibros."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.jpeds.2008.05.005","article-title":"Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report","volume":"153","author":"Farrell","year":"2008","journal-title":"J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"15010","DOI":"10.1038\/nrdp.2015.10","article-title":"Cystic fibrosis","volume":"1","author":"Ratjen","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jcf.2013.05.013","article-title":"Induced sputum compared to bronchoalveolar lavage in young, non-expectorating cystic fibrosis children","volume":"13","author":"Blau","year":"2014","journal-title":"J. Cyst. Fibros."},{"key":"ref_20","unstructured":"Sons, J.W. (2025, March 30). Clinical Microbiology Procedures Handbook, Available online: https:\/\/www.wiley.com\/en-ae\/Clinical+Microbiology+Procedures+Handbook%2C+4th+Edition-p-9781683673255."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Marsac, C., Berdah, L., Thouvenin, G., Sermet-Gaudelus, I., and Corvol, H. (2021). Achromobacter xylosoxidans airway infection is associated with lung disease severity in children with cystic fibrosis. ERJ Open Res., 7.","DOI":"10.1183\/23120541.00076-2021"},{"key":"ref_22","first-page":"13","article-title":"Emerging cystic fibrosis pathogens and the microbiome","volume":"15","author":"Mahenthiralingam","year":"2014","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.jcf.2013.05.004","article-title":"Achromobacter species in cystic fibrosis: Cross-infection caused by indirect patient-to-patient contact","volume":"12","author":"Hansen","year":"2013","journal-title":"J. Cyst. Fibros."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cools, P., Ho, E., Vranckx, K., Schelstraete, P., Wurth, B., Franckx, H., Ieven, G., Van Simaey, L., Van Daele, S., and Verhulst, S. (2016). Epidemic Achromobacter xylosoxidans strain among Belgian cystic fibrosis patients and review of literature. BMC Microbiol., 16.","DOI":"10.1186\/s12866-016-0736-1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jcf.2006.04.002","article-title":"Chronic infection with Achromobacter xylosoxidans in cystic fibrosis patients; a retrospective case control study","volume":"5","author":"Pressler","year":"2006","journal-title":"J. Cyst. Fibros."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jcf.2014.05.008","article-title":"Increasing nontuberculous mycobacteria infection in cystic fibrosis","volume":"14","author":"Mussaffi","year":"2015","journal-title":"J. Cyst. Fibros."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Veschetti, L., Boaretti, M., Saitta, G.M., Passarelli Mantovani, R., Lleo, M.M., Sandri, A., and Malerba, G. (2022). Achromobacter spp. prevalence and adaptation in cystic fibrosis lung infection. Microbiol. Res., 263.","DOI":"10.1016\/j.micres.2022.127140"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1128\/JCM.01843-16","article-title":"Impact of High Diversity of Achromobacter Populations within Cystic Fibrosis Sputum Samples on Antimicrobial Susceptibility Testing","volume":"55","author":"Dupont","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6413","DOI":"10.1007\/s00253-013-5018-3","article-title":"Comparative genome characterization of Achromobacter members reveals potential genetic determinants facilitating the adaptation to a pathogenic lifestyle","volume":"97","author":"Li","year":"2013","journal-title":"Appl. Microbiol. Biotechnol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2437\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:09:09Z","timestamp":1760029749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/7\/2437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14072437"],"URL":"https:\/\/doi.org\/10.3390\/jcm14072437","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,3]]}}}