Advanced Biomedical Research

Clinical and antimicrobial profile of Acinetobacter spp.: An emerging nosocomial superbug

Authors

1 Department of Microbiology, L.N. Medical College and Research Centre, Bhopal, Madhya Pradesh, India

2 Department of Microbiology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

Abstract

Background: Recently, Acinetobacter has emerged as significant hospital pathogen, notoriously known to acquire antibiotic resistance to most of the commonly prescribed antimicrobials. Many risk factors are associated with Acinetobacter infections, especially in patients in intensive care unit (ICU). This study aims to isolate Acinetobacter from various clinical specimens and to determine its antimicrobial sensitivity pattern.
Materials and Methods: Identification, speciation and antimicrobial sensitivity testing were performed using the standard microbiological techniques. Slime production was also tested by microtiter plate and tube method.
Results: From the processed clinical specimens, 107 Acinetobacter strains (1.02%) were isolated of which 76 (0.74%) isolates were from general wards and 31 (11.96%) were from ICU. Significantly higher percentage of Acinetobacter strains was found in ICU compared with general wards (P < 0.05). Most common Acinetobacter infection was abscess. Infections were more common in males and were associated with major risk factors such as post-surgical, diabetes mellitus, catheterization, extended hospital stay and prolonged antibiotic usage. Acinetobacter baumanii was the most common species isolated to cause abscess, wound infection, etc. 62.61% and 28.97% isolates produced slime by microtiter plate and tube method. Imipenem was most sensitive drug followed by amikacin. Ceftazidime, cefotaxime, piperacillin were most resistant. 43.00% isolates were IPM resistant. A. baumanii was more resistant to commonly used antimicrobials.
Conclusion: Acinetobacter nosocomial infections resistant to most antimicrobials have emerged, especially in ICU. Early identification and continued surveillance of prevalent organism will help prevent the spread of Acinetobacter in hospital environment.

Keywords

1. Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: Microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148-65.  Back to cited text no. 1
    
2. Riley W. Acinetobacter and Moraxella. In: Borriello SP, Murray PR, Funke G, editors. Topley and Wilson's Microbiology and Microbial Infections: Bacteriology. 10 th ed., Vol. 2. London: Hodder Arnold Publication; 2005. p. 1301-11.  Back to cited text no. 2
    
3. Collee JG, Fraser AG, Marmion BP, Simmons A. Mackie and McCartney Practical Medical Microbiology. 14 th ed. New York: Churchill-Livingstone; 1999.  Back to cited text no. 3
    
4. Allen DM, Hartman BJ. Acinetobacter species. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 5 th ed., Vol. 2. Philadelphia: Churchill Livingstone; 2000. p. 2239-44.  Back to cited text no. 4
    
5. Koneman EW, Allen SD, Jande WM, Schreckenberger PC, Winn WC Jr. Koneman's Colour Atlas and Textbook of Diagnostic Microbiology. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.  Back to cited text no. 5
    
6. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: Emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538-82.  Back to cited text no. 6
    
7. Maragakis LL, Perl TM. Acinetobacter baumannii: Epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254-63.  Back to cited text no. 7
    
8. Christensen GD, Simpson WA, Younger JJ, Baddour LM, Barrett FF, Melton DM, et al. Adherence of coagulase-negative Staphylococci to plastic tissue culture plates: A quantitative model for the adherence of staphylococci to medical devices. J Clin Microbiol 1985;22:996-1006.  Back to cited text no. 8
    
9. Christensen GD, Simpson WA, Bisno AL, Beachey EH. Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 1982;37:318-26.  Back to cited text no. 9
    
10. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45:493-6.  Back to cited text no. 10
    
11. Clinical and Laboratory Standard Institute. Performance Standard for Antimicrobial Susceptibility Testing; Eighteenth Informational Supplement; M100-S18. Wayne, PA, USA: CLSI; 2008.  Back to cited text no. 11
    
12. Shete VB, Ghadage DP, Muley VA, Bhore AV. Acinetobacter septicemia in neonates admitted to intensive care units. J Lab Physicians 2009;1:73-6.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13. Agodi A, Zarrilli R, Barchitta M, Anzaldi A, Di Popolo A, Mattaliano A, et al. Alert surveillance of intensive care unit-acquired Acinetobacter infections in a Sicilian Hospital. Clin Microbiol Infect 2006;12:241-7.  Back to cited text no. 13
    
14. Rungruanghiranya S, Somboonwit C, Kanchanapoom T. Acinetobacter infection in the intensive care unit. J Infect Dis Antimicrob Agents 2005;22:77-92.  Back to cited text no. 14
    
15. Houang ET, Chu YW, Leung CM, Chu KY, Berlau J, Ng KC, et al. Epidemiology and infection control implications of Acinetobacter spp. in Hong Kong. J Clin Microbiol 2001;39:228-34.  Back to cited text no. 15
    
16. Prashanth K, Badrinath S. Nosocomial infections due to Acinetobacter species: Clinical findings, risk and prognostic factors. Indian J Med Microbiol 2006;24:39-44.  Back to cited text no. 16
[PUBMED]  Medknow Journal  
17. Patwardhan RB, Dhakephalkar PK, Niphadkar KB, Chopade BA. A study on nosocomial pathogens in ICU with special reference to multiresistant Acinetobacter baumannii harbouring multiple plasmids. Indian J Med Res 2008;128:178-87.  Back to cited text no. 17
[PUBMED]  Medknow Journal  
18. Falagas ME, Karveli EA, Siempos II, Vardakas KZ. Acinetobacter infections: A growing threat for critically ill patients. Epidemiol Infect 2008;136:1009-19.  Back to cited text no. 18
    
19. Joshi SG, Litake GM, Satpute MG, Telang NV, Ghole VS, Niphadkar KB. Clinical and demographic features of infection caused by Acinetobacter species. Indian J Med Sci 2006;60:351-60.  Back to cited text no. 19
[PUBMED]  Medknow Journal  
20. Bennani B, Selmani R, Mahmoud M, Nejjari C, Kanjaa N. Nosocomial pneumonia in mechanically ventilated patients: Prospective study in intensive care unit of Fez University Hospital. Saudi J Anaesth 2008;2:46-51.  Back to cited text no. 20
  Medknow Journal  
21. Rodríguez-Baño J, Martí S, Soto S, Fernández-Cuenca F, Cisneros JM, Pachón J, et al. Biofilm formation in Acinetobacter baumannii: Associated features and clinical implications. Clin Microbiol Infect 2008;14:276-8.  Back to cited text no. 21
    
22. Coelho JM, Turton JF, Kaufmann ME, Glover J, Woodford N, Warner M, et al. Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and Southeast England. J Clin Microbiol 2006;44:3623-7.  Back to cited text no. 22
    
23. Sinha M, Srinivasa H, Macaden R. Antibiotic resistance profile & extended spectrum beta-lactamase (ESBL) production in Acinetobacter species. Indian J Med Res 2007;126:63-7.  Back to cited text no. 23
[PUBMED]  Medknow Journal  
24. Lee SO, Kim NJ, Choi SH, Hyong Kim T, Chung JW, Woo JH, et al. Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: A case-control study. Antimicrob Agents Chemother 2004;48:224-8.  Back to cited text no. 24
    
25. Corbella X, Montero A, Pujol M, Domínguez MA, Ayats J, Argerich MJ, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol 2000;38:4086-95.  Back to cited text no. 25
    
 
Advanced Biomedical Research
Volume 2014, January
January 2014
Pages 1-6