Acinetobacter baumannii

Presented by Ri 沈士雄
 Microbiology
 Acinetobacter > 20 species
 greatest clinical importance >A. baumannii

 Gram (-) coccobacilli

 Non-mobile, aerobic, catalase (+), oxidase (-),
non-fermentative, not reduce nitrate
 Short, broad rod during rapid growth
 Coccobacillary shape in stationary phase
 Pathogenesis
 Opportunistic pathogen…
Virulence
 Survive under dry & iron-deficient conditions
 1/3 polysaccharide capsule, prevent complement
activation, delay phagocytosis
 Fimbriae (adhere to human bronchial epithelium)
 Pili (colonization of environmental surface to form
biofirms)
 Epidemiology
Environmental reservoirs
 Soil, fresh water, vegetables, animals
 Body lice, fleas, ticks
 Asymptomatic skin carriage, nasopharyngeal
carriage
 Epidemiology
In the hospital…
 Environmental surface
 Ventilators, dialysis machines, air ventilation
systems, water sources
 Hands
 Contaminated suction equipment
 Respiratory, urinary, GI tracts & wounds of
patients
 Outbreaks
 Antimicrobial resistance
 Tolerance of desiccation

 Transient hand colonization

 Respiratory care equipment

 Nosocomial pneumonia (ventilator-associated)

followed by bacteremia
 Nosocomial Infection
Risk factors
 High APACHE II score, Prematurity
 Colonization of Acinetobacter
 Mechanical ventilation
 ICU admission, Surgery
 Indwelling catheter
 Length of hospital stay
 Broad spectrum antimicrobial therapy (Imipenem,
fluoroquinolone)
 Warm summer
 Nosocomial Infection
Pneumonia
 Previously colonized & Prolonged intubation
 Mortality rate from 35 ~ 70%

Bloodstream infection
 Respiratory tract, intravenous catheters
 1/3 develop septic shock
 Mortality rate range from 20 ~ 60%
 Nosocomial Infection
Endocarditis
 Rare, Acute onset & aggressive
 Higher mortality in native valves
 6 weeks antimicrobial agent
Meningitis
 Fever, meningeal signs, seizure
 Mortality 20 ~ 30%, surviving patients left with
neurologic deficits
 > 3 weeks antimicrobial agent
 Nosocomial Infection
Soft tissue, bone infection
 Surgical, traumatic wound & burn, prosthetic
material
 10~14 days antimicrobial agents
 Involved extremities & complicated with
osteomyelitis
 Surgical debridement & 4~6 weeks antimicrobial
agents
 Nosocomial Infection
Urinary tract infection
 Pyuria + positive culture + symptoms
 10~14 days antimicrobial agent + catheter removal

Other…
Eye infection
Sinus & ear infection
Peritonitis
 Resistance
Mechanisms
 Antibiotic-altering enzymes (beta-lactams,
carbapenems, aminoglycosides)
 Reduced outer membrane porin expression (beta-
lactams, carbapenems)
 Altered penicillin-binding proteins (beta-lactams,
carbapenems)
 Efflux pumps (beta-lactams, quinolones,
aminoglycosides, tigecycline)
 DNA gyrase and topoisomerase IV mutations
(quinolones)
 Antibiotic Selection
 Carbapenem (drug of choice)
 Ampicillin-sulbactam
 Colistin (98% susceptible, for highly resistant
organism)
 Tigecycline (for multidrug-resistant organism)
 Rifampin (Colistin combination)
 Summary
 Gram (-) coccobacilli
 Nosocomial infection (pneumonia, BSI…)
 Previous colonized, prolonged intubation
 Carbapenem, adjust according to susceptibility
test
 MDRAB (mortality rate, length of hospitalization)
 Please wash your hands