Achromobacter xylosoxidans Endotipsitis Following Transjugular Intrahepatic Portosystemic Shunt Revision: A Case Report of an Unusual Device-Associated Infection

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Transjugular intrahepatic portosystemic shunt (TIPS) infection, or endotipsitis, is a rare but life-threatening complication with limited guidance regarding optimal management.We report a case of endotipsitis caused by Achromobacter xylosoxidans, an opportunistic gram-negative organism known for biofilm formation and multidrug resistance.The case highlights the organism's ability to rapidly develop antimicrobial resistance, complicating treatment and limiting therapeutic options.Unlike many device-related infections, definitive source control is often not feasible because TIPS removal carries a substantial risk of catastrophic hemorrhage.Management relies on prolonged, susceptibility-guided antimicrobial therapy and close multidisciplinary collaboration.This report emphasizes the importance of recognizing A. xylosoxidans as a potential cause of persistent bacteremia in patients with TIPS and the need for further research to guide management of these challenging infections.