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PubMed2005

[Infections caused by Acinetobacter spp. in critically ill ICU patients].

INTRODUCTION: To determine the frequency of infections caused by Acinetobacter spp. in critically ill patients admitted to Spanish intensive care units (ICUs) and to assess the clinical features and outcome. PATIENTS AND METHOD: Prospective, observational, multicenter study. Patients admitted for one or two months to ICUs participating in the Spanish Nosocomial Surveillance Study (ENVIN project) between 1997 and 2003 were included. Patients were classified into the following groups: infected by Acinetobacter spp., infected by other pathogens, and uninfected. RESULTS: In 343 (9.9%) patients from among 3,450 with nosocomial infection, Acinetobacter spp. was one of the pathogens identified in 406 episodes (cumulative incidence, 1.2 episodes per 100 patients). A. baumannii was the predominant species in 357 cases (87.9%). Variables significantly associated with selection of Acinetobacter spp. were medical (OR: 2.47; 95% CI: 1.24-4.91) or traumatic underlying disease (OR: 4.40; 95% CI: 2.20-8.80) and ICU stay (OR: 1.03; 95% CI: 1.02-1.04). The overall mortality rate in ICU patients with infection (31.1%) was similar to that of patients with Acinetobacter spp. infections (31.5%), although in both cases it was significantly higher than mortality in uninfected patients (10.7%). ICU mortality rates in patients with imipenem-resistant and imipenem-sensitive Acinetobacter spp. infections were not significantly different (33.3% vs. 30.0%; p = 0.7283). CONCLUSIONS: Acinetobacter spp. were present in 9.9% of patients with ICU-acquired infection. There were no significant differences in ICU mortality rates between patients with Acinetobacter spp. infection and patients with infections caused by other microorganisms.

APACHE↗
PubMed2006

Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999-2001.

An increase in the number of outbreaks of Acinetobacter infection was notified in The Netherlands during 1999-2001. The present study compared the outbreaks at the species and strain levels, and analysed the epidemiology and control measures at the different locations. For each institute, three representative isolates from three patients were identified to the species and strain levels by genotyping methods. A questionnaire investigated the impact of the outbreak, the control measures that were taken, and the possible effects of the measures. Seven outbreaks were associated with Acinetobacter baumannii (three outbreaks with a strain designated strain A, two outbreaks with a strain designated strain B, and one outbreak each with strains designated C and D). An additional outbreak was caused by genomic species 13TU, which is related closely to A. baumannii. Strains B and D were identified as European clones III and II, respectively. Except for two hospitals with outbreaks caused by strain A, there was no known epidemiological link between the participating hospitals. In all hospitals the outbreak occurred on one or several intensive care units, and spread to other departments was noted in two hospitals. The number of patients affected ranged from six to 66 over a period of 2-22 months. In most outbreaks, patients were the likely reservoir from which spread occurred. In all hospitals, a large panel of measures was required to bring the outbreak to an end. Extensive environmental sampling yielded numerous positive samples in most but not all hospitals.

Acinetobacter↗
PubMed2005

Adult Acinetobacter meningitis and its comparison with non-Acinetobacter gram-negative bacterial meningitis.

Between January 1999 and December 2003, 81 cases of single pathogen-related culture-proven Gram-negative adult bacterial meningitis were identified at Chang Gung Memorial Hospital-Kaohsiung. Of these 81 cases, Acinetobacter infection was found in 13 cases. Clinical and laboratory data of these Acinetobacter meningitis patients were studied and were compared with those of other 68 non-Acinetobacter Gram-negative bacterial meningitis (GNBM) patients. Of the 13 implicated Acinetobacter strains, A. baumannii was the most common (12), and the other was A. lwoffii (1). Eleven of these 13 cases were due to a post-neurosurgical infection. The results of the antibiotic susceptibility test of the 13 Acinetobacter strains from cerebrospinal fluid included ceftriaxone, (1/13, 8%), ciprofloaxin (6/13, 46%), ceftazidime (6/13, 46%), cefepime (7/13, 54%), ampicillin-subtactam (7/13, 54%), imipenem (12/13, 92%) and meropenem (12/13, 92%). One strain with pan-drug resistant A. baumannii (PDRAB) emerged in 2003. A statistically significant difference between Acinetobacter meningitis and non-Acinetobacter GNBM included hydrocephalus and ceftazidime-resistance. A mortality rate was 30% (4/13), and 7 of the other 9 survivals had severe neurologic deficits. The emergence of Acinetobacter infections in adult post-neurosurgical infections, multiple antibiotic resistant characteristics, and the emergence of PDRAB strain remained a challenge of the initial management of this specific meningitis. Use of carbapenem, especially meropenem, could be considered as one of the initial empiric antibiotics chosen for the management of adult post-neurosurgical meningitis.

Acinetobacter Infections↗
PubMed1998

Efficacy of sulbactam alone and in combination with ampicillin in nosocomial infections caused by multiresistant Acinetobacter baumannii.

From March 1995 to March 1997, sulbactam was prospectively evaluated in patients with non-life-threatening multiresistant Acinetobacter baumannii infections. During this period, 47 patients were treated with sulbactam; of them, five were excluded because they had received < or =48 h of sulbactam therapy. A total of 42 patients, 27 males and 15 females with a mean age of 60+/-15 years, were finally evaluated. Infections were as follows: surgical wound, 19; tracheobronchitis, 12; urinary tract, 7; catheter-related bacteraemia, 2; and pneumonia, 2. Eighteen patients received intravenous sulbactam alone (1 g every 8 h) and 24 patients received intravenous sulbactam/ampicillin (1 g:2 g every 8 h) with no major adverse effects. Of the 42 patients, 39 improved or were cured and showed A. baumannii eradication and one patient had persistence of wound infection after 8 days of sulbactam/ampicillin requiring surgical debridement. Two patients died after 3 days of therapy (one of the deaths was attributable to A. baumannii infection). The in-vitro activity of the sulbactam/ampicillin combination was by virtue of the antimicrobial activity exhibited by sulbactam. Killing curves showed that sulbactam was bacteriostatic; no synergy was observed between ampicillin and sulbactam. Our results indicate that sulbactam may prove effective for non-life-threatening A. baumannii infections. Its role in the treatment of severe infections is unknown. However, the current formulation of sulbactam alone may allow its use at higher doses and provide new potential synergic combinations, particularly for those infections by A. baumannii resistant to imipenem.

Acinetobacter↗
PubMed2001

Nosocomial infections due to Acinetobacter baumannii in a neurosurgery ICU.

Invasive infections caused by Acinetobacter baumannii in a post-operative neurosurgery ICU were studied. Sixty one patients admitted during a span of 11 months were culture positive for acinetobacter species from blood and/or CSF samples. They were followed up prospectively for evidence of infection and clinical outcome. 40 cases had clinical evidence of infection due to acinetobacter species while in 21 patients, the isolation of the organism was considered a contaminant. Acinetobacter baumannii was the most common organism associated with invasive infections. Respiratory tract was found to be the most common primary source of infection in patients with bacteraemia or meningitis. The age, sex and pre-operative hospital stay were not significantly different in the two groups (p>0.05), while post-operative hospital stay and mortality was significantly higher in patients with invasive infection (p<0.05). Acinetobacter baumannii was isolated from multiple sites (p<0.05) and repeatedly from the same site (p<0.001) in a significantly higher number of patients with invasive infections. Mortality was high in the patients infected with Acinetobacter baumannii. Even amongst the infected group, the patient shaving meningitis showed a higher mortality as compared to the patients having bacteraemia.

Acinetobacter↗
PubMed2006

[Are isolation measures needed in the hospital management of Acinetobacter baumannii colonizations-infections?].

UNLABELLED: Until 2001, the infection control department of the Besançon university hospital (France) recommended isolation precautions for all patients colonized-infected by Acinetobacter baumannii (Ab) whatever the antibiotic susceptibility of the strain. These systematic isolation procedures were given up at the beginning of 2002 since the number of colonized-infected patients remained stable from 1998 to 2001. OBJECTIVE: The aim of this study was to evaluate the impact of this decision on the risk of Ab infection. METHOD: Incidence rates of colonization-infections that were observed during years 2002 and 2003 were compared with expected incidence rate, based on data from 1998-2001 period. Infection control practices and antibiotics consumption were evaluated for each ward of hospitalisation. Genotyping made it possible to determine diversity of clones inside each unit and the whole hospital. RESULTS: The expected incidence per 1000 patients-days was 0.22 in comparison with observed data in 2002, 0.34 (CI(95%) [0.28-0.42]), and in 2003, 0.53 (CI(95%) [0.45-0.63]). The expected number of Ab bloodstream infections, about two per year compared with the observed numbers in 2002 and 2003 respectively seven and 17. The number of unit with more than three cases per year increased from seven in 1999 to 18 in 2003. Antibiotics consumption did not change significantly. CONCLUSION: Genotyping results show the importance of cross-transmission in these units. Finally, observed results suggest that some measures of isolation precautions in addition to standard precautions are needed to prevent outbreaks of Ab.

Acinetobacter Infections↗
PubMed1999

Acinetobacter baumannii bloodstream infection: clinical features and antimicrobial susceptibilities of isolates.

The number of nosocomial infections caused by Acinetobacter baumannii has increased in recent years. The purposes of this study are to discover the risk factors of transmission to prevent the nosocomial infection of A. baumannii. We retrospectively studied 36 patients with A. baumannii bacteremia at China Medical College Hospital from January 1996 to December 1997. There were 23 males and 13 females. All bacteremia were acquired nosocomially. Malignancy (n = 8) and intracranial hemorrhage (n = 6) were the most common underlying diseases. Only one patient on arterial line disclosed intraarterial catheter-related A. baumannii bacteremia and 3 patients had evidence of A. baumannii pneumonia. Twenty-one patients (58%) had central venous catheters in place at the onset of bacteremia, but none was proven to be catheter-related infection. There were 32 patients (89%) with unknown portal of entry. Multivariate logistic regression analysis revealed that potential risk factors related to A. baumannii bacteremia were prior antimicrobial therapy (P < 0.05). The most common clinical features of A. baumannii bacteremia were, in descending order, fever, leukocytosis, thrombocytopenia and hypotension. Eleven patients (30.6%) died directly from A. baumannii bacteremia. All isolates were resistant to ampicillin, cephalothin, cefonicid and moxalactam. The most alarming evidence was that 19% of isolates showed resistance to imipenem. Our findings emphasized that A. baumannii bacteremia had the following characteristics: usually acquired nosocomially, unknown portal of entry, and high multiresistance, especially the increasing resistance rate to imipenem. Imipenem must be reserved as a last-line agent to treat A. baumannii infections, so we want to suggest that the treatment of choice for A. baumannii is gentamicin, amikacin or ceftazidime.

Acinetobacter Infections↗
PubMed2001

The Increasing Role of Acinetobacter Species As Nosocomial Pathogens.

Among gram-negative organisms playing a significant role in nosocomial infections, Acinetobacter species have attracted increasing attention in intensive care units during the past two decades. Acinetobacter species are implicated in a wide spectrum of infections (eg, bacteremia, nosocomial pneumonia, urinary tract infections, secondary meningitis, superinfections in burn patients). One of the most striking features of Acinetobacter species is their extraordinary ability to develop multiple resistance mechanisms against major antibiotic classes. They have become resistant to broad-spectrum beta-lactams (third-generation cephalosporins, carboxypenicillins, and increasingly to carbapenems); they produce a wide range of aminoglycoside-inactivating enzymes; and most strains are resistant to fluoroquinolones. In Acinetobacter nosocomial infections, the major problems confronting clinicians in intensive care units are related to the severity of Acinetobacter nosocomial infections and to resistance to major antibiotic classes of these organisms.

Journal Article↗
PubMed1989

[Nosocomial infections caused by Acinetobacter. Epidemiology and therapeutic difficulties].

Nosocomial infections due to Acinetobacter calcoaceticus are not easy to treat particularly in intensive-care and surgical units. Our study included 33 cases of nosocomial infections which developed during 1987 in the surgical intensive care unit and in the urology department. Acinetobacter was isolated from various types of nosocomial infections: urinary tract infections (43 per cent); septicaemia (15 per cent); surgical infections (27 per cent) and respiratory tract infections (15 per cent). Forty eight per cent of the patients received an antibiotic therapy and 52 per cent had no specific treatment. The following beta-lactam antibiotics were studied: ticarcilline, mezlocilline, cefotaxime and ceftazidime, and 83 per cent of the strains were TICRMEZRCTXR (phenotype IV). All the strains except one were imipenem susceptible. The study of aminoglycoside resistance in Acinetobacter showed that 91 per cent of the strains were gentamicin resistant (GENR); 25.5 per cent were gentamicin, and amikacin resistant and tobramycin susceptible (GENR AMKR TOBS, phenotype IV), and 45 per cent were GENR TOBR AMKR (phenotype V). Acinetobacter strains were resistant and 63 per cent pefloxacin resistant. Co-trimoxazole resistant strains represented 65 per cent of the strains. Should major antibiotics be used to treat nosocomial infections due to multiresistant Acinetobacter strains? Are prophylaxis, aseptic and surgical procedures sufficient to control these infections?

Acinetobacter Infections↗
PubMed2006

Colistin and rifampicin in the treatment of nosocomial infections from multiresistant Acinetobacter baumannii.

INTRODUCTION: The increased incidence of nosocomial infections by multi-drug resistant Acinetobacter baumannii creates demand on the application of some combinations of older antimicrobials on that species. We conducted the present observational study to evaluate the efficacy of intravenous and aerosolized colistin combined with rifampicin in the treatment of critically patients with nosocomial infections caused by multiresistant A. baumannii. PATIENTS AND METHODS: Critically ill patients with nosocomial infections caused by A. baumannii resistant to all antibiotics except colistin in a medical intensive care unit. Diagnosis of infection was based on clinical data and isolation of bacteria. The bacterial susceptibilities to colistin were tested. Clinical response to colistin+rifampicin was evaluated. RESULTS: Twenty-six patients (43.58+/-18.29 years, Acute Physiology and Chronic Health Evaluation II Score (APACHE II): 6.35+/-2.99), of whom 16 cases of nosocomial pneumonia treated by aerosolized colistin (1x10(6) IU three times/day) associated with intravenous rifampicin (10 mg/kg every 12h), nine cases of bacteraemia treated by intravenous colistin (2x10(6)IU three times/day) associated with intravenous rifampicin (10 mg/kg every 12h) in which three cases associated with ventilator associated pneumonia and one case of nosocomial meningitis treated by intrathecal use of colistin associated with intravenous rifampicin. The clinical evolution was favourable for all ill patients. Concerning side effects, we have noticed a moderate hepatic cytolysis in three patients. CONCLUSION: This is the first clinical report of colistin combined with rifampicin for treatment of A. baumannii infection. Despite the lack of a control group and the limited number of patients, the results seem to be encouraging.

Acinetobacter Infections↗
PubMed2004

[A prospective study on the risk factors of Acinetobacter banmannii bacteremia infection in incubated patients with nosocomial pneumonia].

OBJECTIVE: To study the epidemiology of Acinetobacter baumannii infection in patients with ventilator-associated pneumonia (VAP). METHODS: Prospective clinical study was carried out with 176 episodes of VAP with etiologic diagnosis being followed in two groups. RESULTS: Twenty-six episodes were caused by Acinetobacter baumannii and one hundred-fifty episodes were caused by "other" organisms. Using logistic regression analysis, the risk of VAP due to Acinetobacter baumannii was found to be high in patients with head trauma [odds ratio (OR) = 4.20, 95% confidence interva (CI): 2.72 to 6.48], surgery (OR = 2.88, 95% CI: 1.78 to 4.66), acute respiratory dispnea syndrome (OR = 2.81, 95% CI: 1.19 to 6.64), and large-volume pulmonary aspiration (OR = 6.71, 95% CI: 3.91 to 11.50). CONCLUSIONS: Acinetobacter baumannii pulmonary infection in incubated patients had an epidemiological pattern that different from "other" organisms. Patients with high risk identified in our study might mark the existence of cross-infection during airway manipulation.

Acinetobacter↗
PubMed2006

Air ionisation and colonisation/infection with methicillin-resistant Staphylococcus aureus and Acinetobacter species in an intensive care unit.

OBJECTIVE: To determine effect of negative air ions on colonisation/infection with methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter species in an intensive care unit. DESIGN: Prospective single-centre cross-over study in an adult general intensive care unit. PATIENTS: 201 patients whose stay on the unit exceeded 48 hour's duration. INTERVENTION: Six negative air ionisers were installed on the unit but not operational for the first 5 months of the study (control period). Devices were then operational for the following 5.5 months. MEASUREMENTS AND RESULTS: 30 and 13 patients were colonised/infected with MRSA and Acinetobacter spp., respectively, over 10.5 months. No change in MRSA colonisation/infection was observed compared with the 5 month control period. Acinetobacter cases were reduced from 11 to 2 (p=0.007). CONCLUSION: Ionisers may have a role in the prevention of Acinetobacter infections.

Acinetobacter Infections↗
PubMed2003

[Nosocomial infections caused by Acinetobacter: experience in a neonatal care unit in Casablanca].

Nosocomial infections, caused by Acinetobacter are very common in neonatal intensive care units. They are one of the major health problems. Our retrospective study report 20 cases followed in neonatology care unit of children's hospital in Casablanca from 1998 to 2000. Our aims work were to evalue the incidence and the antibioresistance and to insist for the prevention. Incidence has been estimated to 43% of nosocomial infection confirmed and 0.9% of all hospitalisations. Acinetobacter was isolated from various types of nosocomial infection septicaemia (55%), nosocomial pneumonia (30%) and meningitis (15%). The incidence of resistance was 60% for imipineme, 45% for ciprofloxacin and 30% for amikacine. This multiresistance was often responsible for failure of antibiotic therapy. Mortality was very high (55%). The prevention of nosocomial infection remains essential.

Acinetobacter↗
PubMed2006

Outbreak of infection by carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-58 in Belgium.

Carbapenem-resistant Acinetobacter baumannii isolates were obtained from 17 patients between September 2004 and August 2005 at the Academisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium. These multidrug-resistant isolates, which belonged to a single clone, remained susceptible to colistin and tigecycline only and produced the carbapenem-hydrolyzing oxacillinase OXA-58. This study highlights the importance of the intercountry spread of this beta-lactamase-mediated resistance mechanism and its epidemic evolution.

Acinetobacter Infections↗
PubMed1998

Surveillance of an adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii.

Sporadic infections with Acinetobacter spp., punctuated with prolonged outbreaks of infection involving larger numbers of patients and a particular epidemic strain of Acinetobacter baumannii, have occurred in the adult intensive care unit (ICU) of Nottingham University Hospital since 1985. The aim of this study was to screen patients admitted to the ICU for three or more days during a non-outbreak period in 1994-1995 and to use DNA fingerprinting techniques to compare any isolates of Acinetobacter spp. with isolates obtained from the same ICU during the previous ten years. In the present study, almost 20% of the ICU patients screened during 1994-1995 became colonized with Acinetobacter spp. The commonest species isolated from patients was Acinetobacter baumannii; five different strains were identified by random amplified polymorphic DNA fingerprinting, including the epidemic strain responsible for outbreaks of infection in 1985-1986 and 1992-1993. Environmental sampling yielded Acinetobacter spp. from one or more samples on four occasions; Acinetobacter radioresistens was the commonest species isolated, and Acinetobacter baumannii (not the epidemic strain) was isolated on only one occasion from the environment. The long-term persistence of a potentially epidemic strain in the ICU, even during a non-outbreak period, indicates a need for continued vigilance. Consequently, periodic patient and environmental surveillance, combined with typing of isolates, is recommended for ICUs where significant outbreaks of Acinetobacter infection have occurred in the past.

Acinetobacter↗