ACINETOBACTER

By
Dr. R.Jayaprada, M.D
Assistant Professor,
Dept of Microbiology

Introduction
The name, Acinetobacter, comes from the
Latin word for "motionless," because
they lack cilia or flagella with which to
move.
Have 32 species, A. baumanii and A.
lwoffii have greatest clinical importance.

Introduction
Most species are not significant sources of infection.

However,one

opportunistic

species,

Acinetobacter

baumannii, is found primarily in hospitals and poses a risk to

people who have supressed immunity.
Classified by DNA hybridisation into homology groups called
genomo species within genus Acinetobacter--32 species
Strain commonly isolated in laboratory is the Acinetobacter
calcoaceticus baumannii complex.
>2/3 of Acinetobacter infections are due to A. baumannii.

Acinetobacter calcoaceticus baumannii Complex

A. baumannii (A. antitratus): Glucose oxidising,
non-hemolytic
A. lwoffi: Glucose negative, non-hemolytic
A. hemolyticus: Hemolytic strains

Acinetobacter
Gram-Negative
Coccobacilli
Strictly aerobic
Nonmotile
Nonfermenting
Nonfastidious
Catalase positive
Oxidase negative

Acinetobacter
It has DNA G+C content of 39% to 47%.
Based on more recent taxonomic data, it
was proposed that members of the genus
Acinetobacter should be classified in the
new family Moraxellaceae within the order.

Acinetobacter baumannii
Pinkish colonies on MacConkey agar, acid is
formed without gas in glucose, arabinose, xylose
and occasionally rhamnose
Grows at 44oC
Forms acid in 10% lactose and not in 1% lactose
Final identification done only by DNA
hybridisation

Acinetobacter lwoffi
Yellow colonies on MacConkey agar
Does not acidify sugars
Some strains are oxidase positive

Epidemiology
Environmental reservoirs
Soil
Fresh water
Vegetables
Animals
Body lice, fleas, ticks

Source of Acinetobacter:
Where do these organisms reside?

Dr.T.V.Rao MD

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Environmental Contamination
with Acinetobacter

Hands
Bed rails
Bedside tables
Ventilators
Infusion pumps
Mattresses
Pillows
Air humidifiers
Patient monitors

X-ray view boxes

Curtain rails
Curtains
Equipment carts
Sinks
Ventilator circuits
Floor mops
Respiratory, urinary,
GI tracts & wounds of
patients.
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Growth Requirment
Aerobic
Grow at 44 C
Differential Media
MacConky Agar

Selective Media
CHROM Agar
Leeds Acinetobacter Agar

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MacConky Agar

Leeds Acinetobacter Agar

CHROM Agar

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CHROMagar Acinetobacter agar is the latest addition to

the clinical range of chromogenic media developed by
Dr.Alain Rambach.

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Colony Characters
Colonies are 1 to 2
mm, nonpigmented,
domed, and muciod,
with smooth to pitted
surfaces.
They can't reduce
nitrate or to grow
anaerobically
(different from
Enterobacteriaceae).

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Biochemical Profile
Both A.baumannii and A.lwofii
are Catalase positive and
Oxidase Negative (opposite to
Neisseria spp. or Moraxella
spp.)
A.baumannii ferment glucose,
xylose and lactose but A.lwofii
cannot ferment.

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Common species identified using

Acinetobacter calcoaceticus-baumanii complex: glucoseoxidising nonhemolytic, (A.baumannii can be identified
by OXA-51 typing)
Acinetobacter lwoffii: glucose-negative nonhemolytic
Acinetobacter haemolyticus: haemolytic on blood agar.

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Rapid Detection
Rapid detection of Acinetobacter can be
done by RapID ONE Panel (remel) and
Api 20 E strips. These can differentiate up
to species level.

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Molecular Detection
A.baumannii and A.lwofii can be detected
by PCR.
recA specific primers are used to detect
recA gene in A.baumannii, giving a 382 bp
fragment
est specific primers are used to detect est
gene in A.lwofii, giving a 309 bp product.

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Pathogenesis
Opportunistic pathogen
Survive under dry conditions
Virulence Factors
Polysaccharide capsule, prevent complement
activation, delay phagocytosis
Fimbriae (adhere to human bronchial epithelium)
Pili (colonization of environmental surface to form
biofilms)

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Transmission
Acinetobacter can be
spread from person to
person (infected or
colonized patients), contact
with contaminated surfaces
of exposure to the
environment.

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Acinetobacter Transmission in the

Hospital Setting
Direct or indirect
contact
Contaminated
hands of healthcare
workers
Airborne transmission
via aerosol production
(e.g., hydrotherapy)
may occur

Simor AE et al. Infect Control Hosp Epidemiol 2002;23:261-267.

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Major infections due to

Acinetobacter

Ventilator-associated pneumonia
Urinary tract infection
Bloodstream infection
Secondary meningitis
Skin/wound infections
Endocarditis
CAPD-associated peritonitis
Ventriculitis

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Source of A. baumanii Nosocomial

Bloodstream Infection

The respiratory
tract is an
important
reservoir for
Acinetobacter
bloodstream
infections

Abdominal
infection
19%

Respiratory tract
71%

Central venous
line 8%

N=37
Garcia-Garmendia J-L et al. Clin Infect Dis 2001;33:939-946.

Antibiotic Resistance

Acinetobacter
capable

of

species

are

accumulating

multiple antibiotic resistance

genes,

leading

development

of

to

the

multidrug-

resistant or even panresistant

strains.

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Antibiotic Resistance

Mechanisms

Antibiotic-altering enzymes (beta-lactams, carbapenems,

aminoglycosides)
Reduced outer membrane porin expression (beta-lactams,
carbapenems)
Altered penicillin-binding proteins (beta-lactams,
carbapenems)
DNA gyrase and topoisomerase IV mutations (quinolones)

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Treatment

Multidrug-resistant A. baumannii is a common problem in

many hospitals.
First line treatment is with a Carbapenems antibiotic
such as Imipenem, but carbapenem resistance is
increasingly common.
Other treatment options include Polymyxin, Tigecycline
and Aminoglycosides.

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Treating the Resistant Infections

Colistin and Polymyxin B have been used to treat highly
resistant Acinetobacter infections.

The choice of appropriate therapy is further complicated by

the toxicity of colistin which is mainly renal.

Acinetobacter isolates resistant to colistin and Polymyxin B

have also been reported

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Summary

Opportunistic pathogen
Nosocomial infection
Grow best at aerobic conditions
Can be transmitted by contact
Possessing multi antibiotic resistance.

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Acinetobacter pakistanensis

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Preventing Acinetobacter Transmission in the ICU

General Measures
Hand hygiene
Use of alcohol-based hand sanitizers

Contact precautions
Gowns/gloves
Dedicate non-critical devices to patient room

Environmental decontamination
Prudent use of antibiotics
Avoidance of transfer of patients to Burn Unit from
other ICUs
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Wash your hands and shut them off.

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