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Acinetobacter Differential Diagnoses

  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Mar 15, 2016
 
 

Diagnostic Considerations

The main differential diagnostic problem presented by Acinetobacter is to differentiate colonization from infection, including other aerobic gram-negative bacilli that colonize or infect these fluids, ie, Enterobacter species, Stenotrophomonas maltophilia, Burkholderia cepacia, Pseudomonas aeruginosa, Flavobacterium meningosepticum, and Serratia marcescens.

Because Acinetobacter is predominantly a colonizing organism, the burden of proof is on the clinician to demonstrate its pathogenic role in a given situation.

 
 
Contributor Information and Disclosures
Author

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

References
  1. Nguyen MH, Harris SP, Muder RR, et al. Antibiotic-resistant Acinetobacter meningitis in neurosurgical patients. Neurosurgery. 1994 Nov. 35(5):851-5; discussion 855. [Medline].

  2. Krol V, Hamid NS, Cunha BA. Neurosurgically related nosocomial Acinetobacter baumannii meningitis: report of two cases and literature review. J Hosp Infect. 2009 Feb. 71(2):176-80. [Medline].

  3. Go J, Cunha BA. Acinetobacter baumannii: Infection control implications. Infect Dis Pract. 1999. 23:65-68.

  4. Michalopoulos A, Falagas ME. Treatment of Acinetobacter infections. Expert Opin Pharmacother. 2010 Apr. 11(5):779-88. [Medline].

  5. Giamarellou H. Multidrug-resistant Gram-negative bacteria: how to treat and for how long. Int J Antimicrob Agents. 2010 Dec. 36 Suppl 2:S50-4. [Medline].

  6. Neonakis IK, Spandidos DA, Petinaki E. Confronting multidrug-resistant Acinetobacter baumannii: a review. Int J Antimicrob Agents. 2011 Feb. 37(2):102-9. [Medline].

  7. Cunha BA. Optimal therapy for multidrug-resistant Acinetobacter baumannii. Emerg Infect Dis. 2010 Jan. 16(1):170; author reply 170-1. [Medline]. [Full Text].

  8. Cunha BA. Pharmacokinetic considerations regarding tigecycline for multidrug-resistant (MDR) Klebsiella pneumoniae or MDR Acinetobacter baumannii urosepsis. J Clin Microbiol. 2009 May. 47(5):1613. [Medline]. [Full Text].

  9. Fishbain J, Peleg AY. Treatment of Acinetobacter infections. Clin Infect Dis. 2010 Jul 1. 51(1):79-84. [Medline].

  10. Garnacho-Montero J, Amaya-Villar R. Multiresistant Acinetobacter baumannii infections: epidemiology and management. Curr Opin Infect Dis. 2010 Aug. 23(4):332-9. [Medline].

  11. Abbo A, Carmeli Y, Navon-Venezia S, et al. Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes. Eur J Clin Microbiol Infect Dis. 2007 Nov. 26(11):793-800. [Medline].

  12. Bernards AT, Harinck HI, Dijkshoorn L, et al. Persistent Acinetobacter baumannii? Look inside your medical equipment. Infect Control Hosp Epidemiol. 2004 Nov. 25(11):1002-4. [Medline].

  13. Betrosian AP, Douzinas EE. Ampicillin-sulbactam: an update on the use of parenteral and oral forms in bacterial infections. Expert Opin Drug Metab Toxicol. 2009 Sep. 5(9):1099-112. [Medline].

  14. Buke C, Armand-Lefevre L, Lolom I, et al. Epidemiology of multidrug-resistant bacteria in patients with long hospital stays. Infect Control Hosp Epidemiol. 2007 Nov. 28(11):1255-60. [Medline].

  15. Bukhary Z, Mahmood W, Al-Khani A, et al. Treatment of nosocomial meningitis due to a multidrug resistant Acinetobacter baumannii with intraventricular colistin. Saudi Med J. 2005 Apr. 26(4):656-8. [Medline].

  16. Buxton AE, Anderson RL, Werdegar D, et al. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus. Epidemiologic characteristics. Am J Med. 1978 Sep. 65(3):507-13. [Medline].

  17. Castanheira M, Mendes RE, Jones RN. Update on acinetobacter species: mechanisms of antimicrobial resistance and contemporary in vitro activity of minocycline and other treatment options. Clin Infect Dis. 2014 Dec 1. 59 Suppl 6:S367-73. [Medline].

  18. Castle M, Tenney JH, Weinstein MP, et al. Outbreak of a multiply resistant Acinetobacter in a surgical intensive care unit: epidemiology and control. Heart Lung. 1978 Jul-Aug. 7(4):641-4. [Medline].

  19. Cefai C, Richards J, Gould FK, et al. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect. 1990 Feb. 15(2):177-82. [Medline].

  20. Chao CT, Lee SY, Yang WS, Chen HW, Fang CC, Yen CJ, et al. Acinetobacter peritoneal dialysis peritonitis: a changing landscape over time. PLoS One. 2014. 9(10):e110315. [Medline]. [Full Text].

  21. Chen HP, Lai CH, Chan YJ, et al. Clinical significance of Acinetobacter species isolated from cerebrospinal fluid. Scand J Infect Dis. 2005. 37(9):669-75. [Medline].

  22. Cisneros JM, Rodriguez-Baño J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect. 2002 Nov. 8(11):687-93. [Medline].

  23. Cunha BA. Antibiotic Essentials. 7th ed. Royal Oak, Michigan: Physicians Press; 2008.

  24. Cunha BA. Pseudoinfections and pseudo-outbreaks. Mayhall G, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1999.

  25. Cunha BA. Infections caused by non-fermentative aerobic gram-negative bacilli in the critical care unit. Antibiotics for Clinicians. 2000. 4(S1):11-16.

  26. Cunha BA, Klein NC. Pseudoinfections: A review. Infect Dis Clin Pract. 1995. 4:95-103.

  27. Cunha BA, Klimek JJ, Gracewski J, et al. A common source outbreak of Acinetobacter pulmonary infections traced to Wright respirometers. Postgrad Med J. 1980 Mar. 56(653):169-72. [Medline].

  28. Cunha BA, Visvalingam B, Yannelli B. Pseudomeningitis caused by Acinetobacter baumannii. Am J Infect Control. 1999 Apr. 27(2):179-81. [Medline].

  29. Curcio D, Fernandez F. Acinetobacter spp. susceptibility to tigecycline: a worldwide perspective. J Antimicrob Chemother. 2007 Aug. 60(2):449-50. [Medline].

  30. Dedhia HV, McKnight R. Doripenem: position in clinical practice. Expert Rev Anti Infect Ther. 2009 Jun. 7(5):507-14. [Medline].

  31. Dijkshoorn L, van Dalen R, van Ooyen A, et al. Endemic acinetobacter in intensive care units: epidemiology and clinical impact. J Clin Pathol. 1993 Jun. 46(6):533-6. [Medline].

  32. Dong SX, Wang JT, Chang SC. Activities of doripenem against nosocomial bacteremic drug-resistant Gram-negative bacteria in a medical center in Taiwan. J Microbiol Immunol Infect. 2012 Dec. 45(6):459-64. [Medline].

  33. Drago L, De Vecchi E, Nicola L, et al. Activity of levofloxacin and ciprofloxacin in combination with cefepime, ceftazidime, imipenem, piperacillin-tazobactam and amikacin against different Pseudomonas aeruginosa phenotypes and Acinetobacter spp. Chemotherapy. 2004 Oct. 50(4):202-10. [Medline].

  34. Endimiani A, Luzzaro F, Migliavacca R, et al. Spread in an Italian hospital of a clonal Acinetobacter baumannii strain producing the TEM-92 extended-spectrum beta-lactamase. Antimicrob Agents Chemother. 2007 Jun. 51(6):2211-4. [Medline].

  35. Falagas ME, Kasiakou SK, Michalopoulos A. Antimicrobial resistance of Acinetobacter spp. in Europe. Clin Microbiol Infect. 2004 Dec. 10(12):1106-7. [Medline].

  36. Falagas ME, Kastoris AC, Karageorgopoulos DE, Rafailidis PI. Fosfomycin for the treatment of infections caused by multidrug-resistant non-fermenting Gram-negative bacilli: a systematic review of microbiological, animal and clinical studies. Int J Antimicrob Agents. 2009 Aug. 34(2):111-20. [Medline].

  37. Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. 2006 Mar 1. 42(5):692-9. [Medline].

  38. Freire MP, Van Der Heijden IM, do Prado GV, Cavalcante LS, Boszczowski I, Bonazzi PR, et al. Polymyxin use as a risk factor for colonization or infection with polymyxin-resistant Acinetobacter baumannii after liver transplantation. Transpl Infect Dis. 2014 Jun. 16(3):369-78. [Medline].

  39. French GL, Casewell MW, Roncoroni AJ. A hospital outbreak of antibiotic-resistant Acinetobacter anitratus: epidemiology and control. J Hosp Infect. 1980 Jun. 1(2):125-31. [Medline].

  40. Fulnecky EJ, Wright D, Scheld WM, et al. Amikacin and colistin for treatment of Acinetobacter baumannii meningitis. J Infect. 2005 Dec. 51(5):e249-51. [Medline].

  41. Getchell-White SI, Donowitz LG, Gröschel DH. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol. 1989 Sep. 10(9):402-7. [Medline].

  42. Go CH, Joseph T, Cunha BA. Acinetobacter baumanii line-associated infection. Heart Lung. 2000 May-Jun. 29(3):222-4. [Medline].

  43. Gozdas HT. Diagnosis of acinetobacter baumannii infections. Int J Prev Med. 2012 Nov. 3(11):817. [Medline]. [Full Text].

  44. Haddad FA, Van Horn K, Carbonaro C, et al. Evaluation of antibiotic combinations against multidrug-resistant Acinetobacter baumannii using the E-test. Eur J Clin Microbiol Infect Dis. 2005 Aug. 24(8):577-9. [Medline].

  45. Hartstein AI, Rashad AL, Liebler JM, et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med. 1988 Nov. 85(5):624-31. [Medline].

  46. Hung YT, Lee YT, Huang LJ, Chen TL, Yu KW, Fung CP, et al. Clinical characteristics of patients with Acinetobacter junii infection. J Microbiol Immunol Infect. 2009 Feb. 42(1):47-53. [Medline].

  47. Irwin RS, Demers RR, Pratter MR, et al. An outbreak of acinetobacter infection associated with the use of a ventilator spirometer. Respir Care. 1980 Feb. 25(2):232-7. [Medline].

  48. Jaggi N, Sissodia P, Sharma L. Control of multidrug resistant bacteria in a tertiary care hospital in India. Antimicrob Resist Infect Control. 2012 Jun 6. 1(1):23. [Medline]. [Full Text].

  49. Jamal W, Salama M, Dehrab N, Al Hashem G, Shahin M, Rotimi VO. Role of tigecycline in the control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Hosp Infect. 2009 Jul. 72(3):234-42. [Medline].

  50. Jamal WY, Al Hashem G, Khodakhast F, Rotimi VO. Comparative in vitro activity of tigecycline and nine other antibiotics against gram-negative bacterial isolates, including ESBL-producing strains. J Chemother. 2009 Jun. 21(3):261-6. [Medline].

  51. Kang SJ, Kang CI, Park SY, et al. Epidemiology and clinical features of community-onset Acinetobacter baumannii infections. Infect Control Hosp Epidemiol. 2012 Oct. 33(10):1053-5. [Medline].

  52. Kasiakou SK, Fragoulis K, Tzagarakis G, et al. Cure of multidrug-resistant Acinetobacter baumannii fixation device-related orthopedic infections in two patients with intravenous colistin. Microb Drug Resist. 2005. 11(3):287-9. [Medline].

  53. Kelkar R, Gordon SM, Giri N, et al. Epidemic iatrogenic Acinetobacter spp. meningitis following administration of intrathecal methotrexate. J Hosp Infect. 1989 Oct. 14(3):233-43. [Medline].

  54. Kuo LC, Lai CC, Liao CH, et al. Multidrug-resistant Acinetobacter baumannii bacteraemia: clinical features, antimicrobial therapy and outcome. Clin Microbiol Infect. 2007 Feb. 13(2):196-8. [Medline].

  55. Lee CM, Lim HK, Liu CP, et al. Treatment of pan-drug resistant Acinetobacter baumannii. Scand J Infect Dis. 2005. 37(3):195-9. [Medline].

  56. Marroni M, Pasquarella C, Agodi A, et al. Clonal spread of Acinetobacter baumannii in a general intensive care unit. Ann Ig. 2004 Jan-Apr. 16(1-2):95-102. [Medline].

  57. Minnaganti VR, Cunha BA. Acinetobacter baumanii-associated arterial line infection. Am J Infect Control. 2000 Oct. 28(5):376-7. [Medline].

  58. Mizrahi A, Lambert T, Vidal B, Couzigou C, Nguyen Van JC, Le Monnier A. Pseudo-Outbreak of Oxa-23-Mediated Carbapenem-Resistant Acinetobacter baumannii in Urinary Tract Infections Caused by an Automated Urine Analyzer. Infect Control Hosp Epidemiol. 2014 Nov. 35(11):1440-1. [Medline].

  59. Montero A, Corbella X, Ariza J. Clinical relevance of Acinetobacter baumannii ventilator-associated pneumonia. Crit Care Med. 2003 Oct. 31(10):2557-9. [Medline].

  60. Mortensen E, Trivedi KK, Rosenberg J, Cody SH, Long J, Jensen BJ, et al. Multidrug-resistant Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility providing subacute care. Infect Control Hosp Epidemiol. 2014 Apr. 35(4):406-11. [Medline].

  61. Motaouakkil S, Charra B, Hachimi A, et al. Colistin and rifampicin in the treatment of nosocomial infections from multiresistant Acinetobacter baumannii. J Infect. 2006 Oct. 53(4):274-8. [Medline].

  62. Munoz-Price LS, Zembower T, Penugonda S, Schreckenberger P, Lavin MA, Welbel S, et al. Clinical outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections: study of a 2-state monoclonal outbreak. Infect Control Hosp Epidemiol. 2010 Oct. 31(10):1057-62. [Medline].

  63. Murray CK, Hospenthal DR. Treatment of multidrug resistant Acinetobacter. Curr Opin Infect Dis. 2005 Dec. 18(6):502-6. [Medline].

  64. Navon-Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother. 2007 Apr. 59(4):772-4. [Medline].

  65. Pachon-Ibanez ME, Jimenez-Mejias ME, Pichardo C, et al. Activity of tigecycline (GAR-936) against Acinetobacter baumannii strains, including those resistant to imipenem. Antimicrob Agents Chemother. 2004 Nov. 48(11):4479-81. [Medline].

  66. Paterson DL, Depestel DD. Doripenem. Clin Infect Dis. 2009 Jul 15. 49(2):291-8. [Medline].

  67. Patterson JE, Vecchio J, Pantelick EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med. 1991 Nov. 91(5):479-83. [Medline].

  68. Peacock JE Jr, Sorrell L, Sottile FD, et al. Nosocomial respiratory tract colonization and infection with aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus: epidemiologic characteristics and clinical significance. Infect Control Hosp Epidemiol. 1988 Jul. 9(7):302-8. [Medline].

  69. Petrosillo N, Chinello P, Proietti MF, et al. Combined colistin and rifampicin therapy for carbapenem-resistant Acinetobacter baumannii infections: clinical outcome and adverse events. Clin Microbiol Infect. 2005 Aug. 11(8):682-3. [Medline].

  70. Pimentel JD, Low J, Styles K, et al. Control of an outbreak of multi-drug-resistant Acinetobacter baumannii in an intensive care unit and a surgical ward. J Hosp Infect. 2005 Mar. 59(3):249-53. [Medline].

  71. Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences. J Hosp Infect. 2007 Mar. 65(3):204-11. [Medline].

  72. Rahal JJ. Antimicrobial resistance among and therapeutic options against gram-negative pathogens. Clin Infect Dis. 2009 Aug 15. 49 Suppl 1:S4-S10. [Medline].

  73. Rigatto MH, Ribeiro VB, Konzen D, Zavascki AP. Comparison of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia and tracheobronchitis caused by Pseudomonas aeruginosa or Acinetobacter baumannii. Infection. 2012 Nov 4. [Medline].

  74. Ristuccia PA, Cunha BA. Acinetobacter. Infect Control. 1983 Jul-Aug. 4(4):226-9. [Medline].

  75. Ritchie DJ, Garavaglia-Wilson A. A review of intravenous minocycline for treatment of multidrug-resistant acinetobacter infections. Clin Infect Dis. 2014 Dec 1. 59 Suppl 6:S374-80. [Medline].

  76. Rodríguez-Baño J, Cisneros JM, Fernández-Cuenca F, et al. Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals. Infect Control Hosp Epidemiol. 2004 Oct. 25(10):819-24. [Medline].

  77. Rosa R, Depascale D, Cleary T, Fajardo-Aquino Y, Kett DH, Munoz-Price LS. Differential environmental contamination with Acinetobacter baumannii based on the anatomic source of colonization. Am J Infect Control. 2014 Jul. 42(7):755-7. [Medline].

  78. Sands M, McCarter Y, Sanchez W. Synergy testing of multidrug resistant Acinetobacter baumanii against tigecycline and polymyxin using an E-test methodology. Eur J Clin Microbiol Infect Dis. 2007 Jul. 26(7):521-2. [Medline].

  79. Schafer JJ, Goff DA, Stevenson KB, et al. Early experience with tigecycline for ventilator-associated pneumonia and bacteremia caused by multidrug-resistant Acinetobacter baumannii. Pharmacotherapy. 2007 Jul. 27(7):980-7. [Medline].

  80. Seifert H, Baginski R, Schulze A, et al. Antimicrobial susceptibility of Acinetobacter species. Antimicrob Agents Chemother. 1993 Apr. 37(4):750-3. [Medline].

  81. Stephens C, Francis SJ, Abell V, et al. Emergence of resistant Acinetobacter baumannii in critically ill patients within an acute care teaching hospital and a long-term acute care hospital. Am J Infect Control. 2007 May. 35(4):212-5. [Medline].

  82. Taccone FS, Rodriguez-Villalobos H, De Backer D, et al. Successful treatment of septic shock due to pan-resistant Acinetobacter baumannii using combined antimicrobial therapy including tigecycline. Eur J Clin Microbiol Infect Dis. 2006 Apr. 25(4):257-60. [Medline].

  83. Tan TY, Ng LS, Tan E, et al. In vitro effect of minocycline and colistin combinations on imipenem-resistant Acinetobacter baumannii clinical isolates. J Antimicrob Chemother. 2007 Aug. 60(2):421-3. [Medline].

  84. Tega L, Raieta K, Ottaviani D, et al. Catheter-related bacteremia and multidrug-resistant Acinetobacter lwoffii. Emerg Infect Dis. 2007 Feb. 13(2):355-6. [Medline].

  85. Ullman RF, Schoch PE, Cunha BA. Pseudomeningitis due to Acinetobacter CDC Group VE-1 organisms. Clin Microbiol Newslett. 1988. 10:6-8.

  86. Vandenbroucke-Grauls CM, Kerver AJ, Rommes JH, et al. Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis. 1988 Aug. 7(4):485-9. [Medline].

  87. Wareham DW, Bean DC. In vitro activities of polymyxin B, imipenem, and rifampin against multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother. 2006 Feb. 50(2):825; author reply 825-6. [Medline].

  88. Wood CA, Reboli AC. Infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis. 1993 Dec. 168(6):1602-3. [Medline].

  89. Wood GC, Hanes SD, Boucher BA, et al. Tetracyclines for treating multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia. Intensive Care Med. 2003 Nov. 29(11):2072-6. [Medline].

  90. Zhong Q, Xu W, Wu Y, Xu H. Clonal spread of carbapenem non-susceptible Acinetobacter baumannii in an intensive care unit in a teaching hospital in China. Ann Lab Med. 2012 Nov. 32(6):413-9. [Medline]. [Full Text].

  91. Zhou H, Yang Q, Yu YS, et al. Clonal spread of imipenem-resistant Acinetobacter baumannii among different cities of China. J Clin Microbiol. 2007 Dec. 45(12):4054-7. [Medline].

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