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PubMed1991

Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit.

PURPOSE: Acinetobacter calcoaceticus var. anitratus is an important nosocomial pathogen that has been associated with environmental reservoirs. An increased isolation rate of A. anitratus in our intensive care units (ICUs), from 0.03% (two of 7,800) to 0.5% (seven of 1,300) (p less than 0.00003), prompted an investigation. PATIENTS, METHODS, AND RESULTS: Ten patients were admitted to the surgical ICU and nine to the medical ICU during the outbreak period (late December 1987 to January 1988). Controls were all patients on the units who were not infected or colonized with the transmitted strain of A. anitratus. Three patients had A. anitratus pneumonia. A throat culture prevalence survey demonstrated three patients colonized with A. anitratus. Cases were placed in a cohort and symptomatic cases treated. An epidemiologic investigation was conducted to identify reservoirs and modes of transmission. Latex gloves were being used for universal precautions without routine changing of gloves between patients. Environmental sources culture-positive for A. antitratus included a small volume medication nebulizer and gloves in use for patient care. Plasmid typing showed that plasmid profiles of isolates from two symptomatic patients, two colonized patients, the nebulizer, and the gloves were identical. Other A. anitratus ICU isolates had distinct plasmid profiles. All patients with the transmitted strain had been in the surgical ICU. The need for changing gloves between patients and contaminated body sites was reinforced. CONCLUSION: Gloves, used incorrectly for universal precautions, may potentially transmit A. anitratus.

Acinetobacter Infections↗
PubMed1995

Detection of alpha/beta-hydrolase fold in the cell surface esterases of Acinetobacter species using an analysis of 3D profiles.

The primary sequence of esterases from Acinetobacter lwoffii RAG-1 and A. calcoaceticus BD413 were compared with linearized structural sequences of two hundred proteins selected from Brookhaven Protein DataBank using a modified version of the Bowie et al. algorithm [3]. Significant structural homology was found to alpha/beta proteins and specifically to those with the alpha/beta-hydrolase fold for which the crystal structure was reported. No such homology was detected using common primary sequence alignment programs such as FASTA or BLAST.

Acinetobacter↗
PubMed1986

Investigation of an outbreak of infection with Acinetobacter calcoaceticus in a special care baby unit.

During a period of 6 months, an 'epidemic strain' of Acinetobacter calcoaceticus was isolated from 10 pre-term neonates in a special care baby unit (scbu). Of these, nine had pulmonary infections. The tenth was found to have conjunctival colonization only. The 'epidemic strain' was characterized by serotyping, biotyping, bacteriocin typing and antibiograms. An identical strain was isolated from an 'Ambu' resuscitation device but not from other environmental samples or from staff on the unit. The outbreak ceased after the colonized resuscitator was removed and an appropriate disinfection policy implemented for the replacement resuscitators.

Acinetobacter↗
PubMed1987

Endemic occurrence of Acinetobacter calcoaceticus biovar anitratus in an intensive care unit.

One strain of Acinetobacter calcoaceticus biovar anitratus caused colonization of 111 patients admitted to an intensive care unit (ICU) during a 2-year period. All patients were intubated and had received antibiotic therapy prior to colonization. Morbidity due to the organism was about 1%. The colonization rate showed a decreasing trend during the study period, but no seasonal variation. The strain was found in the air in a low concentration and on the hands of 8-13% of the members of the staff. No chronic carriers were found.

Acinetobacter↗
PubMed1989

Frequency of plasmids in strains of Acinetobacter calcoaceticus.

Plasmids were found in 75 out of 93 clinical isolates of Acinetobacter calcoaceticus. The strains harboured up to 20 plasmids each, with two-thirds containing two or more. Most plasmids were smaller than 15 Md. Strains of A. Iwoffi contained more plasmids than A. anitratus. Plasmid analysis may be an easy and valuable tool in the epidemiology of A. calcoaceticus, especially in conjunction with other typing methods.

Acinetobacter↗
PubMed1994

Epidemiological markers of Acinetobacter baumannii clinical isolates from a spinal cord injury unit.

During a period of 28 months, 114 isolates of Acinetobacter baumannii obtained from urine samples of 57 patients, were recovered in a Spinal Cord Unit; an unusual increase in the number of A. baumannii isolates was observed between February 1991 and January 1992. Six different typing methods [biotyping, antimicrobial susceptibility, whole cell and cell-envelope protein analysis, plasmid analysis and chromosomal DNA analysis by pulsed-field gel electrophoresis (PFGE)] were used to study the isolates to establish any potential relationships among them. Chromosomal DNA analysis by digestion with ApaI and separation of the fragments by PFGE was the most powerful tool to determine the relatedness of isolates. The results suggest that the isolates from 1991 and 1992 may have originated from strains present in 1990 that subsequently acquired resistance to amikacin and tobramycin during the epidemic.

Acinetobacter↗
PubMed1994

Acinetobacter calcoaceticus anitratus outbreak in the intensive care unit traced to a peak flow meter.

BACKGROUND: A cluster of seven cases of Acinetobacter caleoaceticus anitratus in a community teaching hospital intensive care unit was discovered (the seventh case was located in a step-down unit next to an infected patient recently transferred from the intensive care unit.) METHODS: An outbreak investigation, including detailed epidemiologic, clinical, and laboratory investigation, was performed. RESULTS: A single strain of A. calcoaceticus anitratus was responsible for infection in all seven patients. All patients had tracheostomies, were in respiratory failure, and were ventilator dependent. Patients ranged in age from 27 to 81 years. No common causative variable or explanatory findings were present except that the same peak flow meter (manual weaning criteria machine) was used to facilitate weaning all seven patients from mechanical ventilation. Culture of the mouthpiece isolated a A. calcoaceticus anitratus strain with the identical susceptibility pattern and biochemical profile as that from the infected patients. CONCLUSION: A. calcoaceticus anitratus was transmitted by a peak flow meter nosocomially to seven patients receiving mechanical ventilation. Disposable mouthpieces were introduced to prevent cross-contamination. A 2% glutaraldehyde solution was used to disinfect the machine between uses. No further outbreaks of A. calcoaceticus anitratus pneumonia were identified during 3 years of follow-up.

Acinetobacter Infections↗
PubMed1992

Esterase electrophoresis compared with biotyping for epidemiological typing of Acinetobacter baumannii strains.

Forty-nine Acinetobacter baumannii strains belonging to three biotypes and isolated from four hospitals were differentiated by electrophoretic typing of their esterases. Six main kinds of esterases were distinguished by their spectra of hydrolytic activity toward seven synthetic substrates. The electrophoretic variations of these enzymes were used to define ten zymotypes among the three biotypes. Esterase electrophoresis appeared to be more sensitive than biotyping, and could represent an additional marker for epidemiological analysis.

Acinetobacter↗
PubMed1995

In vitro activities of antimicrobial agents, alone and in combination, against Acinetobacter baumannii isolated from blood.

In vitro activities of 15 antimicrobial agents against 90 strains of Acinetobacter baumannii isolated from blood cultures from hospitalized patients were determined using the agar dilution method. Imipenem, ofloxacin, and ciprofloxacin had the best antimicrobial activity with minimum inhibitory concentrations (MIC50s) of 0.25 mu g/ml and MIC90s of 0.5-1 mu g/ml. beta-lactam antibiotics other than imipenem had poor activity, with MIC50s ranging from 8 to 64 mu g/ml and MIC90s from 32 to > or = 256 mu g/ml. The checkerboard titration method was used to study the effects of combination of two antimicrobial agents. Combinations of ceftazidime, aztreonam, imipenem, or ciprofloxacin with amikacin showed either synergistic effects or partial synergistic effects for 40.9%-86.4% of 22 tested strains. The best in vitro activity was observed with the combination of imipenem and amikacin. No antagonistic effects were observed with the combination of imipenem and amikacin. Synergistic effects were confirmed by time-kill curve studies. In conclusion, imipenem, ofloxacin, and ciprofloxacin were the three most active agents against human blood isolates of A. baumannii. The combination of a beta-lactam or ciprofloxacin with amikacin was synergistic for some of the isolates.

Acinetobacter↗
PubMedDate not supplied

Acinetobacter calcoaceticus infection following a dog bite.

A frequent complication of dog bite wounds is bacterial infection. The choice of antibiotics is based upon the most likely organisms. Failure to achieve wound healing suggests that an uncommon organism(s) is present and should lead the clinician to culture the wound. A case of Acinetobacter calcoaceticus infection following a dog bite is described.

Acinetobacter↗
PubMedDate not supplied

Comparison of arbitrarily primed polymerase chain reaction and cell envelope protein electrophoresis for analysis of Acinetobacter baumannii and A. junii outbreaks.

Two successive Acinetobacter outbreaks in a neonatal intensive care unit were studied with arbitrarily primed polymerase chain reaction (AP-PCR), cell envelope protein electrophoresis (protein fingerprinting) and antibiotic susceptibility testing. AP-PCR fingerprinting and protein fingerprinting yielded identical clustering of the isolates studied. Susceptibility test results were useful for rapid recognition of the outbreaks, but clustering of several isolates was different from the clustering obtained with AP-PCR fingerprinting and protein fingerprinting. Typing results indicated that the two outbreaks, which occurred at a three-month interval, were each caused by a single strain, and that both strains differed from the strains prevailing in the hospital. The strain of one outbreak was identified as A. junii, a species commonly not involved in outbreaks. A. baumannii isolates collected from different departments of this hospital during a period of four years clustered into only five different types. Moreover, strains from different departments of a second hospital belonged to the type prevailing in the first hospital, although there were no apparent connections between the two institutions. This may indicate that only a limited number of strains of the A. calcoaceticus-baumannii complex are involved in nosocomial outbreaks.

Acinetobacter↗
PubMed2004

Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital.

We conducted a case-control study to determine the attributable direct costs of multidrug-resistant Acinetobacter baumannii (MDRAB) in the burn unit of a public teaching hospital. The mean total hospital cost of patients who acquired MDRAB was 98,575 dollars higher than that of control patients who had identical burn severity of illness indices ( P <.01). These data should help infection control practitioners and others determine the cost-effectiveness of specific interventions designed to control this emerging nosocomial pathogen.

Acinetobacter Infections↗
PubMed2006

Acinetobacter mediastinitis in a heart transplant patient.

We report a 56-year-old who underwent orthotopic heart transplantation following left ventricular assist device bridge to transplantation. His postoperative course was complicated by severe sternal wound infection with Acinetobacter species requiring extensive debridement and reconstruction with a pectoralis major flap. This was followed by a total sternectomy, pectoralis flap debridement, and vacuum-assisted dressing.

Acinetobacter↗
PubMed2004

Two consecutive outbreaks of Acinetobacter baumanii 1-a in a burn Intensive Care Unit for adults.

UNLABELLED: Acinetobacter baumanii is generally a highly antibiotic resistant micro-organism that can be easily transmitted between inpatients of ICUs. We report two consecutive outbreaks of A. baumanii in a burn ICU. MATERIAL AND METHODS: All patients with ICU-stay greater than 2 days were subject to a strict epidemiological surveillance after admission, recording age, sex, TSBA, etc. and follow-up data such as antibiotherapy, instrumentation, infections, etc. We also monitored the microbial flora evolution and their resistance to antibiotic by weekly cultures of pharynx, rectum, skin (healthy and burned), etc. Because of an "epidemic" microorganism, infection control procedures, were increased. We studied the colonization by other prevalent microorganisms: MR-S. aureus and Pseudomonas aeruginosa. RESULTS: Seventy-two burn patients were followed in 1 year. Only 4.1% were infected at some site by A. baumanii, but 1/3 of patients were colonized by this microorganism, distributed in two outbreaks, one in the first trimester, after admission in the Unit of two non-burned and colonized patients (from another ICU). The second epidemic began in July and probably was due to transitory colonization of skin or fomites by health personnel working in both ICUs. All the isolates (from both ICUs) of A. baumanii were identical by PFGE. The length of hospital stay was the main risk factor for colonization. P. aeruginosa and MR-S. aureus showed a tendency to be endemo-epidemic at all times. CONCLUSION: Our cross colonization control measures showed a limited efficacy our burn patients. Therefore, we must impede the introduction to burn ICUs of epidemic microorganisms by colonized patients or heath personnel by restriction of admission of A. baumanii colonized patients from other ICUs (if the treatment can be administered in this ICU) and by strict disinfection/antiseptic procedures.

Acinetobacter Infections↗
PubMed2005

Prevalence of metallo-beta-lactamase among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates.

The prevalence of metallo-beta-lactamases (MBLs) produced by isolates of Pseudomonas aeruginosa and Acinetobacter baumannii and the activities of various antmicrobial combinations against MBL producer strains were investigated. During the period from June 2003 till July 2004, 120 P. aeruginosa and 9 A. baumannii nonduplicate isolates were obtained from burn wounds. Forty strains (37 P. aeruginosa, 3 A. baumannii) were selected because of resistance to carbapenems. Screening for MBL production was performed in the latter isolates by the combined disk method which depends on comparing the zones given by disks containing imipenem with and without ethylenediaminetetraacetic acid (EDTA). Of imipenem resistant P. aeruginosa strains, 21 and 1 of A. baumannii were found metallo-beta-lactamase producers. Disk approximation studies were then performed to test for in vitro activities of various antimicrobial combinations. For a total of 21 P. aeruginosa strains, synergy was demonstrated predominantly by ciprofloxacin in combination with ceftazidime and imipenem, by ofloxacin in combination with astreonam. Against MBL producer A. baumannii strain, synergy was detected only with imipenem-ofloxacin combination. None of the combinations were antagonistic. These results suggest that MBL producing P. aeruginosa and A. baumanni strains have been introduced into burn centers, and to prevent the further spread of MBL producers, it is essential for carbapenem resistant isolates to be screened for MBLs.

Acinetobacter Infections↗
PubMed2026

A plasmid-associated immunoglobulin-binding protein in Acinetobacter baumannii.

BACKGROUND: Acinetobacter baumannii is a critical global health threat due to multidrug resistance and high mortality. Although antimicrobial resistance mechanisms are well characterised, the virulence determinants that drive severe infections remain poorly understood. METHODS: We screened 89 carbapenem-resistant clinical isolates of A. baumannii for virulence in animal infection models and combined comparative genomics with functional assays to identify virulence factors. An immunoglobulin-binding protein from A. baumannii (ImbA) encoded on the type D plasmid was selected and characterised. Protein-immunoglobulin interactions were analysed by pull-down and biolayer interferometry. Additional ImbA inhibition of IgG-Fc&#x3b3; receptor binding by flow cytometry were tested. Protective efficacy was evaluated in mice using vaccination or anti-ImbA antibodies. FINDINGS: A type D plasmid was consistently linked to high virulence in clinical isolates. The deletion of plasmid-encoded ImbA attenuated virulence. ImbA bound murine IgA and IgG with high affinity. The binding to the Fc region of IgG disrupted IgG-Fc&#x3b3; receptor interactions. Vaccination with recombinant ImbA improved survival and reduced bacterial dissemination in female mice with anti-ImbA antibodies partially protecting against lethal infection. Bacterial burdens in the blood were reduced in treated groups. INTERPRETATION: Our study demonstrates ImbA as an unrecognised plasmid-encoded virulence factor in A. baumannii. By intercepting host immunoglobulins, ImbA drives immune evasion and hypervirulence. Blocking ImbA by vaccination and antibody therapy restored host defence and improved outcomes in female mice, highlighting ImbA as a non-antibiotic therapeutic target with potential against multidrug-resistant A. baumannii. FUNDING: Bio&Medical Technology Development Program of the National Research Foundation (NRF), funded by the Korean government (MSIT) (No. RS-2023-00219213); Korea Research Institute of Bioscience and Biotechnology (KRIBB) Research Initiative Program.

Animals↗
PubMed2005

Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit.

An outbreak of Acinetobacter baumannii colonization and infection occurred in 19 patients over a 14-month period during 1998-1999 on a neurosurgical intensive care unit. During efforts to control the outbreak a significant correlation was observed between the number of environmental isolates of A. baumannii obtained during each monthly screening and the number of patients with A. baumannii colonization/infection in the same calendar month (P=0.004). Use of 1000 ppm hypochlorite solution and the introduction of new cleaning protocols reduced the number of environmental isolates. Failure to maintain low levels of environmental contamination with A. baumannii resulted in increases in patient colonization. This study showed that high standards of cleaning play an integral role in controlling outbreaks of A. baumannii in the intensive care unit setting.

Acinetobacter Infections↗