Acinetobacter

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

Background

Acinetobacter baumannii is a pleomorphic aerobic gram-negative bacillus (similar in appearance to Haemophilus influenzae on Gram stain) commonly isolated from the hospital environment and hospitalized patients. A baumannii is a water organism and preferentially colonizes aquatic environments. This organism is often cultured from hospitalized patients' sputum or respiratory secretions, wounds, and urine. In a hospital setting, Acinetobacter commonly colonizes irrigating solutions and intravenous solutions.

Acinetobacter species have low virulence but are capable of causing infection in organ transplants and febrile neutropenia. Most Acinetobacter isolates recovered from hospitalized patients, particularly those recovered from respiratory secretions and urine, represent colonization rather than infection. Care must be exercised in determining whether the isolate is due to colonization or is truly causing infection. Multiple factors tend to increase the risk for acquiring an Acinetobacter infection, including prior antibiotic exposure, intensive care unit admission, use of a central venous catheter, and mechanical ventilation or hemodialysis use.

When Acinetobacter infections occur, they usually involve organ systems that have a high fluid content (eg, respiratory tract, CSF, peritoneal fluid, urinary tract). These infections may occur as outbreaks rather than isolated cases of nosocomial pneumonia. Infections may complicate continuous ambulatory peritoneal dialysis (CAPD) or cause catheter-associated bacteruria. The presence of Acinetobacter isolates in respiratory secretions in intubated patients may represent colonization. Acinetobacter pneumonias occur in outbreaks and are usually associated with colonized respiratory-support equipment or fluids. The 2005 IDSA guidelines for hospital-acquired pneumonia discuss the role of Acinetobacter as a cause of nosocomial pneumonia. Nosocomial meningitis may occur in colonized neurosurgical patients with external ventricular drainage tubes. [1, 2]

A baumannii is inherently resistant to multiple antibiotics.

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Pathophysiology

When Acinetobacter causes actual infection, the pathological changes that occur depend on the organ system involved. The pathological changes, as observed in patients with pneumonia, are indistinguishable from those caused by other noncavitating aerobic gram-negative bacilli that cause nosocomial pneumonias. Similarly, Acinetobacter urinary tract infections are clinically indistinguishable from catheter-associated bacteremias caused by other aerobic gram-negative bacilli.

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Epidemiology

Frequency

International

Acinetobacter commonly colonizes patients in the intensive care setting. Acinetobacter colonization is particularly common in patients who are intubated and in those who have multiple intravenous lines or monitoring devices, surgical drains, or indwelling urinary catheters. Acinetobacter infections are uncommon and occur almost exclusively in hospitalized patients.

Mortality/Morbidity

Although Acinetobacter is primarily a colonizer in the hospital environment, it occasionally causes infection. Mortality and morbidity resulting from A baumannii infection relate to the underlying cardiopulmonary immune status of the host rather than the inherent virulence of the organism.

Mortality and morbidity rates in patients who are very ill with multisystem disease are increased because of their underlying illness rather than the superimposed infection with Acinetobacter.

Race

Acinetobacter infection has no known racial predilection.

Sex

Acinetobacter infection has no known sexual predilection.

Age

Acinetobacter infection has no known predilection for age.

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