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PubMed2002

Corneal ulcer of the side port after phacoemulsification induced by Acinetobacter baumannii.

A 75-year-old man had clear corneal phacoemulsification using a temporal approach in the left eye. Two months after surgery, a focal corneal epithelial defect developed with infiltration near the lower limbus on the site of the side-port incision. The culture of corneal scrapping grew Acinetobacter baumannii, which is resistant to most ordinary antibiotics in sensitivity tests. After appropriate antibiotic treatment, the ulcer healed gradually with vessel ingrowth. Acinetobacter baumannii is usually found in nosocomial infection of immune-compromised patients in the intensive care unit. It is a rare pathogen of infectious keratitis. Our case, with its unusual infection site, may point to potential risk factors for this pathogen.

Acinetobacter↗
PubMed1992

The clinical significance of Acinetobacter baumannii in blood cultures.

Acinetobacter baumannii was isolated from blood cultures in 31 patients in 4 intensive care units at a large teaching hospital over a period of 6 months. In 23 of these patients, Acinetobacter was also isolated from tracheal aspirates. Catheter-related infection could be identified as the cause of bacteremia in 14 cases, whereas pneumonia was present in only 6 cases. All patients were seriously ill and 7 (24%) died of their infection.

Acinetobacter↗
PubMed1995

Comparative classification of Acinetobacter baumannii strains using seven different typing methods.

A group of 49 Acinetobacter baumannii strains obtained from several hospital outbreaks and some sporadic cases were typed by biotyping, antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), plasmid typing, multilocus enzyme electrophoresis, whole-cell protein profile, and Fourier-transform infrared (FT-IR) spectroscopy. All these methods have shown a high degree of reproducibility and are capable of recognising strains from the same epidemiological event. However, their power to discriminate between epidemiologically unrelated strains varies, with PFGE being superior to the other methods investigated. FT-IR spectroscopy, which has not yet been used for typing of Acinetobacter strains, proved to be a very rapid and highly reproducible method, but was somewhat limited in its discriminating power.

Acinetobacter↗
PubMed1989

A comparative assay of epidemiological markers for Acinetobacter strains isolated in a hospital.

A comparative assay for epidemiological evaluation of three different Acinetobacter typing procedures, i.e. biotyping, phage-typing, and the analysis of the bacterial envelope protein profiles, was carried out using sixty-four multiresistant Acinetobacter strains isolated from clinical specimens. The antibiotic susceptibility of the strains was also considered. After geno-species identification, biotyping allowed the recognition of a relatively large and long-lasting presence, at an Intensive Therapy Unit, of two A. baumannii biotypes. Phage-typing and the analysis of the susceptibility to antibiotics allowed for the differentiation of strains belonging to different geno-species and biotypes, and in some cases also to the same biotypes. On the contrary, the analysis by polyacrylamide gel electrophoresis of the cell-envelope proteins failed to show any diversity not only within, but also between some of the biotypes of A. baumannii, the most prevalent species of the genus in the hospital environment.

Acinetobacter↗
PubMed1990

Comparison of clinical Acinetobacter strains using a carbon source growth assay.

A quantitative carbon source growth assay, comprising ten carbon sources, was used to compare acinetobacter strains from three hospitals. The strains had been obtained during episodes of increased prevalence of isolations and were, for each hospital, assumed to be epidemiologically related. This assumption was supported by the electrophoretic protein profiles of the strains. Univariate analysis of growth data showed significant differences between strains from the three hospitals. Moreover, cluster analysis revealed that the major pattern in the data was related to the epidemiological origin of the strains. Exceptions to the epidemic-related pattern were observed. Thus, apart from epidemiological factors, other factors might contribute to carbon source growth profiles of the strains. It is concluded that the carbon growth assay may be useful to distinguish roughly between acinetobacter strains from different sites of origin. Further studies are required to analyse additional factors which influence carbon source growth of strains.

Acinetobacter↗
PubMed1993

Genetic diversity and clonal relationships of Acinetobacter baumannii strains isolated in a neonatal ward: epidemiological investigations by allozyme, whole-cell protein and antibiotic resistance analysis.

Sixty-five strains of Acinetobacter baumannii which had been isolated from patients and the indoor environment of a neonatal intensive care unit and, for comparative purposes, isolates from three other wards, were examined by means of electrotyping and analysis of whole-cell protein and antibiotic resistance patterns. Fourteen different electrotypes were determined. The predominant type, a multiply resistant acinetobacter clone, persisted in the neonatal ward over several months. The results underline the usefulness of electrophoretic subtyping, in particular by means of allozyme pattern and as a supplement to whole-cell protein pattern analysis, in epidemiological investigations into the routes of transmission of nosocomial A. baumannii infections.

Acinetobacter↗
PubMed1987

Typing of Acinetobacter calcoaceticus strains isolated from hospital patients by cell envelope protein profiles.

The usefulness of sodium dodecyl sulphate-polyacrylamide gel electrophoresis patterns of cell envelope proteins for classifying strains of Acinetobacter calcoaceticus was studied using 129 isolates from 16 in-patients in a teaching hospital. In 11 patients, all of the isolates from each patient exhibited the same pattern irrespective of the body site or time of isolation. The patterns of the isolates from four other patients were indistinguishable, with the exception of one isolate per patient. In the isolates from one patient five patterns were observed. In several cases isolates from different patients exhibited the same pattern. The relative frequency of some of these patterns was low. Epidemiological data were compatible with the assumption that the concurrent presence of bacteria of these patterns in the patients was the result of cross-infection. For one pattern, which was seen in seven patients, cross-infection could not be substantiated. On the basis of analysis of electrophoretic patterns in combination with epidemiological data on a number of strains it is concluded that cell-envelope protein profiles appear to be a useful aid in studying the dissemination of Acinetobacter in the hospital environment.

Acinetobacter↗
PubMed2004

Acinetobacter skin abscess in a neonate.

Although Acinetobacter is usually a species of low virulence, it is becoming increasingly more important as a cause of hospital outbreaks, particularly on intensive care units. Antibiotic resistance can develop rapidly. This organism has not been reported to cause skin abscesses previously. We describe a case of a neonate who developed an Acinetobacter abscess on our neonatal intensive care unit.

Abscess↗
PubMed2003

Multiresistant Acinetobacter baumannii isolates in intensive care units in Greece.

One hundred and twenty-one clinical isolates of Acinetobacter baumannii recovered from the intensive care units (ICUs) of nine tertiary-care hospitals in Athens, Greece were studied in order to determine whether the increasing appearance of resistant acinetobacters is due to the spread of epidemic strains. The majority of the isolates exhibited resistance to ampicillin-sulbactam, and the most common antibiotic resistance profiles comprised resistance to nine and eight of the 11 potentially active antibiotics tested, respectively. Pulsed-field gel electrophoresis showed that 68% of the isolates, recovered from all ICUs, belonged to two clonal groups, indicating inter-hospital dissemination of multiresistant A. baumannii in our region.

Acinetobacter Infections↗
PubMed1999

Isolation of Acinetobacter spp. including A. baumannii from vegetables: implications for hospital-acquired infections.

A. baumannii is rarely recovered from the skin of patients or healthy European subjects as other genospecies predominate, but it isa significant nosocomial pathogen. The natural reservoir of this organism is therefore uncertain. We determined the isolation rates of Acinetobacter spp. from vegetables (as an indicator of the natural environment) using a selective technique and classified the genospecies by amplified ribosomal DNA restriction analysis (ARDRA). Of the 177 samples of vegetables examined, 30 yielded Acinetobacter, with genospecies 2 and 11 being the most common, each with a frequency of 27%. MIC assays showed that strains of genospecies 1, 2, 3, and 13TU (the A. calcoaceticus-A. baumannii complex) were significantly more resistant than other genospecies to ciprofloxacin and gentamicin. Vegetables may therefore be a natural habitat of A. baumannii and provide a route by which these bacteria are introduced into hospitals with obvious implications for infection control.

Acinetobacter↗
PubMed2003

Healthcare-associated outbreak due to pan-drug resistant Acinetobacter baumannii in a surgical intensive care unit.

Acinetobacter baumannii is ubiquitous and has recently become one of the most important healthcare-associated (HA) pathogens in hospitals. Infection caused by this organism often leads to significant morbidity and mortality. Outbreaks of pan-drug resistant Acinetobacter baumannii (PDRAB) have rarely been reported. During a two-month period, an outbreak of PDRAB colonization and infection affecting 7 patients occurred in our surgical intensive care unit (SICU). The colonized sites were respiratory tract (N = 7) and central venous catheter (N = 2). One of the patients had a surgical wound infection. Extensive environmental contamination was identified, including sites such as bed rails, bedside tables, surface of ventilators and infusion pump, water for nasogastric feeding and ventilator rinsing and sinks. All of the isolates were analysed by pulsed-field gel electrophoresis (PFGE) and showed an identical pattern. After use of strict cohort nursing, hand hygiene environmental cleaning, and replacement of a dysfunctional high-efficiency particulate air filter (HEPA), the outbreak was controlled.

Acinetobacter Infections↗
PubMedDate not supplied

Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients: the iceberg phenomenon again.

OBJECTIVE: To determine the prevalence and antimicrobial susceptibility patterns of Acinetobacter baumannii on the hands and nares of health care workers and patients from intensive care and rehabilitation units at two hospitals in northern Manhattan, New York. DESIGN: Prevalence survey of Acinetobacter on the hands and anterior nares of staff (n = 184) and patients (n = 98) in rehabilitation and intensive care units of two hospitals. RESULTS: Twenty subjects (7.1%) had positive test results for A baumannii (6 staff [3.3%] and 14 patients [14.3%]). Five patients had positive test results at both sites, four in the nares only, and 11 on hands only. Among patients, four significant predictors of A baumannii were days on unit (P = .003), location (hospital A or B) (P = .01), surgery (P = .04), and receiving an antifungal agent (P = .02; OR, 5.6; 95% CI, 1.25-24.52). Among staff, predictors were skin damage (P = .02) and employment in hospital B (P = .03). Nine of the 20 subjects (45%) had positive test results for multiresistant strains, one from a staff member and eight from patients. CONCLUSION: Patients whose conditions are not clinically symptomatic for A baumannii, as well as staff, are often colonized. Staff with damaged skin are more likely to be colonized. Control of this organism will only be possible when the principle of the iceberg phenomenon--all patients (and staff) treated with standard, Universal Precautions--is strictly followed. Further, the endemic prevalence of multiresistant strains may be higher than previously appreciated.

Acinetobacter Infections↗
PubMed2001

Outbreak of Acinetobacter baumannii in an intensive care unit associated with tracheostomy.

A case-control study was conducted to determine risk factors for acquisition of an epidemic strain of Acinetobacter baumannii in an intensive care unit. The epidemic strain was identified by pulsed-field gel electrophoresis and was isolated from tracheal secretions in 13 (87%) of 15 patients. In a logistic regression analysis, presence of a tracheostomy was an independent risk for Acinetobacter sp acquisition (odds ratio, 421; 95% confidence interval, 13.8-12925; P =.001) and the strength of the association was inversely related to the duration of mechanical ventilation. The outbreak coincided with the introduction of a policy of early percutaneous tracheostomy in the intensive care unit and probably resulted from inadequate infection control practices during respiratory care. No environmental reservoir was found. Institution of contact precautions, enhanced handwashing, and staff education was associated with resolution of the outbreak.

Acinetobacter↗
PubMed2003

The epidemiology of multidrug-resistant Acinetobacter baumannii: does the community represent a reservoir?

OBJECTIVE: To explore the role of the community as a potential reservoir for Acinetobacter baumannii. DESIGN: Antimicrobial resistance patterns and genotypes of A. baumannii isolates from patients in two Manhattan hospitals were compared with those of A. baumannii isolates from the hands of community members. RESULTS: A total of 103 isolates from two hospitals (hospital A, 81; hospital B, 22) and 23 isolates from community residents were studied. Of the hospital isolates, 36.6% were multidrug resistant (hospital A, 68.2%; hospital B, 27.8%). In contrast, there were no multidrug-resistant isolates from the community (P < .005 between hospital and community). The prevalence of A. baumannii on the hands of community residents was 10.4% (23 of 222). By molecular typing, 42 strains of A. baumannii were identified. Of the isolates from hospital A and hospital B, 55.6% (45 of 81) and 68.2% (15 of 22), respectively, were indistinguishable or closely related. In contrast, most community (83.3%) isolates were unrelated (P = .001 between hospital and community). CONCLUSION: Acinetobacter isolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.8% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains of A. baumannii.

Acinetobacter Infections↗
PubMed2005

Concurrent outbreak of multidrug-resistant and susceptible subclones of Acinetobacter baumannii affecting different wards of a single hospital.

BACKGROUND AND OBJECTIVE: Acinetobacter baumannii has emerged as an opportunistic pathogen among acutely ill patients, especially those with thermal injury. A prospective 8-month study was conducted to describe the clinical and molecular epidemiology of multidrug-resistant A. baumannii affecting a single hospital. METHODS: Univariate analysis comparing SmaI macrorestriction patterns of A. baumannii generated by pulsed-field gel electrophoresis (PFGE) versus clinical and demographic risk factors. RESULTS: A total of 200 isolates from 76 patients were collected, of which 185 isolates from 76 patients were analyzed by PFGE. A total of 17 distinct PFGE clonal types were identified. One clonal type (strain A) represented 129 isolates from 49 patients. A group of related clonal types (strain A variants) were identified as 40 isolates from 20 patients. The only risk factor other than geographic location associated with the presence of strain A was prior treatment with antibiotics active against gram-negative bacteria (P = .0015). The two clonal types differed in antibiotic resistance profiles: 25% of strain A isolates, the dominant strain in the burn unit, were susceptible to at least one antibiotic tested. In contrast, approximately 80% of the other strain types were susceptible to at least one antibiotic and were cultured from patients admitted elsewhere in the hospital. No combination of antibiotics was observed to yield additive or synergistic activity. CONCLUSION: Clonally related strains of Acinetobacter that differ in susceptibility patterns may coexist within a single hospital, dependent on the selective pressure related to antibiotic exposure.

Acinetobacter Infections↗
PubMed2006

Epidemiology of Acinetobacter baumannii in a university hospital in Turkey.

OBJECTIVE: Molecular epidemiologic surveillance of Acinetobacter baumannii by polymerase chain reaction-randomly amplified polymorphic DNA analysis in a university hospital for 3 consecutive study periods. RESULTS: Twelve different Acinetobacter baumannii genotypes (A-L) were detected. Although only 2 genotypes were detected during the first period and genotype A appeared to be the most common genotype, genotype D was included in these genotypes during the second study period. Genotype A completely disappeared during the third period. Although the presence of genotype C and the genotype D continued during the third period, 9 new genotypes were detected during this period. Genotype A appeared to be the most common genotype in the hospital (detected in 19 different clinics). The distribution of genotypes in clinical samples correlated with patient traffic between them. Some genotypes were found in both clinical and environmental samples. Seventeen different antibiotypes were detected, according to antibiotic susceptibility profiles. CONCLUSIONS: Environmental contamination, airborne transmission, patient transfer, and cross-contamination play important roles in epidemics caused by A. baumannii in our hospital. The distribution of genotypes can change over time, so antibiotyping is not appropriate for the epidemiological analysis of A. baumanii infection.

Acinetobacter Infections↗
PubMed2006

Clinical culture surveillance of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species in a teaching hospital in Sao Paulo, Brazil: a 7-year study.

Carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species are worrisome nosocomial pathogens. After introduction of a preventive program involving clinical surveillance culture to reduce the spread of those pathogens, we observed an 80% decrease in the percentage of cultures that yielded carbapenem-resistant Acinetobacter isolates. The percentage of cultures that yielded carbapenem-resistant P. aeruginosa remained relatively stable during the intervention.

Acinetobacter↗
PubMed1994

Plasmid DNA profiles of Acinetobacter baumannii: clinical application in a complex endemic setting.

OBJECTIVE: To study the epidemiological, microbiological, and clinical features of infections due to Acinetobacter baumannii in a complex endemic situation over an 18-month period and to determine the clinical usefulness of plasmid DNA analysis of A baumannii in epidemiological investigations. DESIGN: Review of medical and laboratory records. Antibiotic resistance patterns, biotyping, and plasmid profile analysis were used to characterize clinical and environmental isolates. Pulsed-field gel electrophoresis (PFGE) of chromosomal DNA was performed to verify results obtained with the other typing methods. SETTING: Four different intensive care units of an 800-bed tertiary care center in Cologne, Germany. RESULTS: 240 patients were colonized or infected with A baumannii during the study period. No seasonal variations were observed. The majority of isolates (53%) were recovered from the respiratory tract. Major infections occurred in 61 patients; these included 48 bacteremias and eight pulmonary infections. Five different epidemic strains were identified: one each was A baumannii biotype 2 and 6, and three were biotype 9. A baumannii biotype 9 accounted for the vast majority of isolates (88%), which were clustered into three epidemic strains demonstrating distinct plasmid profiles. Two of these were considered genetically related as shown by PFGE. Epidemic strains were multidrug resistant, being uniformly susceptible to imipenem only. An epidemiological investigation failed to identify any point source of infection. Barrier precautions and improved handwashing was instituted in three of the four units and significantly reduced the incidence of colonization and infection in these units. Attack rates remained unchanged, however, in the burns unit where control measures were not implemented. CONCLUSION: Acinetobacter strains representing multiple biotypes and plasmid types were present in this endemic setting. Multidrug resistance in A baumannii is an important concern. Plasmid DNA analysis proved to be useful in epidemiological typing of A baumannii strains and may serve as a complementary typing system to traditional epidemiological methods.

Acinetobacter↗