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Pandrug-resistant Acinetobacter baumannii

Industry of interest: Healthcare

Classification: Bacteria

Microbiology: Acinetobacter baumannii is a non-fermentative aerobic Gram-negative rod. A. baumannii is an opportunistic human pathogen that has become increasingly prevalent since the 1970s with the increasing use of broad-spectrum antibiotics in hospitals (Towner, 2009). Pandrug-resistant (PDR) A. baumannii is resistant to all available antibiotics.

 

Biology

Habitat and transmission: A. baumannii forms part of the normal microflora of between 25-70% of the population (Joly-Guillou, 2005).A. baumannii infections appear to be concentrated in intensive care units (ICUs), burns wards, high dependency units (HDUs) and other areas where very sick patients reside (Towner, 2009). There has also been a trend of military personnel in Iraq and Afghanistan acquiring A. baumannii infections upon repatriation (Towner, 2009). It is thought that A. baumannii can also be spread by airborne transmission, person-to-person contact, through contaminated environmental surfaces and medical equipment. Infected patients are the primary reservoir of infection as they shed microorganisms back into the environment (Towner, 2009).

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Treatment and antibiotic resistance: Recently there has been a surge in the number outbreaks due to multidrug-resistant (MDR) A. baumannii strains that are resistant to all currently available antibiotics. “Last line” treatment of PDR A. baumannii infections may include use of combined therapies with polymyxins and tigecycline. These have a bacteriostatic effect on A. baumannii but have limited efficacy and harmful side effects. The emergence of PDR A. baumannii, which are resistant to even these “last line” drugsis a dangerous development because it means that there are no effective antibiotic therapies.

Prevention and control: A. baumannii is highly resistant to the effects of desiccation and disinfection and as such is able to persist in the environment for long periods of time. Prevention and control strategies commonly include increased emphasis on hand hygiene, enhanced environmental cleaning and disinfection, the isolation of affected patients and the use of contact precautions. However, the epidemiology of A. baumannii is poorly understood so detailed studies are required to identify effective prevention and control strategies (Joly-Guillou, 2005).

Disease and symptoms: A. baumannii causes skin and soft tissue infections, ventilator-associated pneumonia, wound infections, urinary tract infections, secondary meningitis and bacteraemia (Towner, 2009). A. baumannii is a particular problem to patients on mechanical ventilation, burns patients and trauma patients.

References:
Joly-Guillou M.L. (2005)
Clinical impact and pathogenicity of Acinetobacter. Clin Microbiol Infect. 11(11): 868-873.

Towner K.J. (2009) Acinetobacter: An old friend, but a new enemy. J Hosp Infect. 73(4): 355-363.

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