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AN UPDATE
Dr.T.V.Rao MD
DR.T.V.RAO MD
ACINETOBACTER BAUMANNII
Acinetobacter baumannii is a Gram negative bacteria. It is typically a short, almost round, rodshape (coccobacillus). It can be an opportunistic pathogen in humans, affecting people with compromised immune systems and is becoming increasingly important as a hospital derived infection (nosocomial). It has also been isolated from soil and water samples in the environment.
DR.T.V.RAO MD
CURRENT TAXONOMY
The genus Acinetobacter, as currently defined, comprises gram-negative, strictly aerobic, Nonfermenting, nonfastidious, nonmotile, catalase-positive, oxidase-negative bacteria with a 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
DR.T.V.RAO MD
ACINETOBACTER - MOTIONLESS The name, Acinetobacter, comes from the Latin word for "motionless," because they lack cilia or flagella with which to move. 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:
DR.T.V.RAO MD
DR.T.V.RAO MD
MICROBIOLOGY
Oxidase negative Nitrate negative
Catalase positive
Nonfermentative Nonmotile
Strictly aerobic
Gram negative coccobacillus
Sometimes difficult to decolorize
Frequently arranged in pairs Bergogne-Brzin E, Towner KJ. Clin Microbiol Rev 1996;9:148-165.
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MORPHOLOGY IS DISTINCTIVE
Rod shaped during rapid growth and Coccobacillary in the stationary phase.
Encapsulated (generally). Nonmotile (although they may exhibit twitching motility).
Gram-negative organisms. Retention of crystal violet may result in incorrect identification as gram-positive cocci.
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Ubiquitous:
MICROBIOLOGY
Widely distributed in nature (soil, water, food, sewage) & the hospital environment
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BIOCHEMICAL REACTIONS
Oxidase negative
(opposite to Neisseria spp. or Moraxella spp.)
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BIOCHEMICAL REACTIONS
Acidify glucose (may enhance its ability to invade devitalized tissue). Grow at 44 C. Aerobic. Acinetobacter spp have the ability to use various sources of nutrition which accounts for its growth on routine laboratory media. This also explains its survival as an environmental pathogen.
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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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Carbapenemases
Quantitative and/or qualitative changes in outer membrane porins Altered penicillin-binding proteins.
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METALLO--LACTAMASES:
Common in the Far East, rare in Europe. Various VIM & IMP types (plasmid mediated).
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biofilms with enhanced antibiotic resistance and, more recently, that a chaperone-usher secretion system involved in Pilus assembly affects biofilm formation
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with Iraqnobacter (Acinetobacter baumannii) due to its spread throughout the military hospitals. Many times soldiers have survived hellacious trauma on the battlefield only to succumb to even more damage by an organism that has picked up antimicrobial resistance factors to the drugs primarily associated with treating them almost impossible.
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MICROBIOLOGICAL INVESTIGATION
Acinetobacter baumannii isolates were presumptively identified by using morphology of the colonies, Gram staining, Oxidase and Catalase reactions, growth at 44C, and the API-20 NE System (Bio-Merieux, Lyon, France) Identification as A. baumannii was verified by restriction analysis of the 16S23S ribosomal RNA intergenicspacer sequences,
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ACINETOBACTER OUTBREAKS
Detection of Acinetobacter Infections
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TREATMENT
Carbapenems (Imipenem and Meropenem) are the mainstay of treatment for antimicrobial-resistant gram-negative infections, though Carbapenemsresistant Acinetobacter is increasingly reported. Resistance to the Carbapenems class of antibiotics makes multidrug-resistant Acinetobacter infections difficult, if not impossible, to treat.
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ORIGIN OF IRAQIBACTER
Where the Iraqibacter came from remains something of a mystery. Soil samples taken by researchers in Iraq and Kuwait came back negative. However, it was found thriving in the hospitals. When Iraqibacter was compared to MDRAB samples taken in Europe before the war, they were found to be identical (Silberman, 2007). Thus, scientists believe that the current outbreak originated from European sources. ( So MDRAB did exist before the Iraq War.)
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Secondary meningitis
Skin/wound infections Endocarditis
CAPD-associated peritonitis
Ventriculitis
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ACINETOBACTER MENINGITIS
Most cases are hospital-acquired
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Bedside tables
Ventilators Infusion pumps Mattresses Pillows Air humidifiers Patient monitors
Equipment carts
Sinks Ventilator circuits Floor mops
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Extensive environmental contamination Highly antibiotic resistant High proportion of colonized patients Frequent contamination of the hands of healthcare workers
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Ear
Nose Throat Axilla
35%
33% 15% 33%
7%
8% 0% 3%
Hand
Groin Perineum Toe web Any site
33%
38% 20% 40% 75%
20%
13% 3% 8% 42.5%
Seifert H et al. J Clin Microbiol 1997; 51 35:2819-2825.
Outbreak of multidrug resistant A. baumannii in a Dutch ICU involving 66 patients with an epidemic strain Nursing staff were cultured (nares & axilla, same swab)
15 nurses found to harbor epidemic strain All were culture negative when re-cultured (nose, throat, axilla, perineum)
Wagenvoort JHT et al. Eur J Clin Microbiol Infect Dis 2002;21:326-327. DR.T.V.RAO MD
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S. aureus
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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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PREVENTING ACINETOBACTER TRANSMISSION IN THE ICU OUTBREAK INTERVENTIONS Hand cultures Surveillance cultures Environmental cultures following terminal disinfection to document cleaning efficacy Cohorting Ask laboratory to save all isolates for molecular typing Healthcare worker education If transmission continues despite above interventions, closure of unit to new admissions
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Removal Rate
Light contamination Fingertips inoculated Plain soap with either 103 CFU 99.97% 70% Ethyl alcohol (light contamination) 99.98% or 106 CFU (heavy 99.98% 10% Povidone-iodine contamination) 4% Chlorhexidine 99.81%
Cardoso CL et al. Am J Infect Control 1999;27:327-331. DR.T.V.RAO MD
Heavy contamination
92.40% 98.94% 98.48% 91.39%
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Agent
Plain soap
Light contamination
99.97% 99.98% 99.98% 99.81%
Heavy contamination
92.40% 98.94% 98.48% 91.39%
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-Patients admitted from long term care facilities with endemic Acinetobacter -Patients with previous history of Acinetobacter infection
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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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SIMPLE AND SCIENTIFIC HAND WASHING CAN REDUCE INFECTIONS WITH A.BAUMANNII TOO
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Programme Created by Dr.T.V.Rao MD for Medial and Health care Workers in the Developing World
Email
doctortvrao@gmail.com
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