Acinetobacter spp. are aerobic, Gram-negative coccobacilli commonly found in soil, water, and human skin and throat flora. These bacteria, which include over 34 identified species, are non-motile but exhibit twitching motility, thriving optimally at 33-37°C.
Clinically, Acinetobacter baumannii is the most significant due to its high virulence and multidrug resistance, leading to severe infections and high mortality rates in immunocompromised patients and those with multi-organ disease.
Acinetobacter baumannii primarily spread in healthcare settings, particularly in ICUs, causing infections such as ventilator-associated pneumonia, bloodstream infections, and wound infections.
Management involves removing infected devices, debridement of necrotic tissue, and using effective antibiotics like meropenem, colistin, and sulbactam.
The increasing antibiotic resistance of Acinetobacter baumannii poses significant challenges, necessitating stringent infection control measures and continuous epidemiological surveillance.
Acinetobacter baumannii is a member of Acinetobacter spp., which are aerobic Gram-negative coccobacilli commonly found in soil, water, and as part of the human skin and throat flora. [2.]
The genus has undergone extensive taxonomic revisions, and modern molecular techniques have identified over 34 species. [2.]
Acinetobacter spp. are non-motile, although some exhibit twitching motility, and are strictly aerobic, thriving optimally at 33-37°C. [2., 3.]
Although generally low in virulence, it can cause serious infections in immunocompromised patients and those with multi-organ disease. [3.]
Clinically, Acinetobacter baumannii, A. nosocomialis, and A. pittii are the most significant, with A. baumannii being particularly notorious for its high virulence and multidrug resistance, often leading to severe infections and high mortality rates. [3., 4.]
These bacteria primarily spread in healthcare settings; Acinetobacter baumannii thrive in hospital settings, especially in ICUs, where they can cause ventilator-associated pneumonia, bloodstream infections, urinary tract infections and wound infections among critically ill patients. [3.]
Management of Acinetobacter baumannii infections involves the removal of infected devices, thorough debridement of necrotic tissue, and the use of effective antibiotics such as meropenem, colistin, and sulbactam. [3.]
Their resistance to common antibiotics poses significant challenges in healthcare, necessitating stringent infection control measures and continuous epidemiological surveillance.
One of the most notable characteristics of Acinetobacter spp. is their ability to develop resistance to multiple classes of antibiotics. This resistance is best studied in relationship to the antibiotic resistance seen with Acinetobacter baumannii, considered the most virulent and antibiotic-resistant strain.
A. baumannii has developed a well-known antibiotic resistance to carbapenem. Carbapenem belongs to the beta-lactam family of antibiotics, which includes penicillins and cephalosporins.
The rising trend of carbapenem resistance in Acinetobacter baumannii is concerning due to limited therapeutic options. This resistance is attributed to several mechanisms:
These enzymes hydrolyze carbapenems efficiently, rendering them ineffective against A. baumannii by breaking down the antibiotic molecules.
These enzymes hydrolyze carbapenems, with varying efficiencies, contributing significantly to resistance by deactivating the antibiotic.
The OXA-51/69 variants, when overexpressed, can hydrolyze carbapenems and reduce the susceptibility of A. baumannii to these antibiotics.
Loss or alteration of the CarO protein and other porins reduces carbapenem uptake into the bacterial cell, thereby decreasing the antibiotic's effectiveness.
Alterations in PBPs reduce the binding affinity of carbapenems, thereby diminishing their antibacterial activity.
Virulence factors are molecules produced by pathogens that contribute to their ability to cause infection and disease in their host.
Many of the virulence factors associated with Acinetobacter spp. have been identified and studied while researching A. baumannii, the most pathogenic strain of Acinetobacter spp.
Virulence factors associated with A. baumannii include:
LPS is a lipid A component that induces inflammatory cytokines and contributes to serum resistance, aiding in immune evasion and promoting inflammatory responses.
Synthesized by the K-locus gene cluster, CPS aids in immune evasion, resistance to phagocytosis, desiccation, and antibiotic penetration, enhancing virulence and mucoid phenotype formation.
Phospholipase C and D disrupt epithelial cell membranes, contribute to cytotoxicity, and aid in iron acquisition by lysing human erythrocytes.
Utilizes siderophores, outer membrane vesicles, and heme molecules to acquire iron, crucial for survival and virulence. Acinetobactin, a major siderophore, facilitates iron uptake under acidic conditions, enhancing colonization and infection.
These regulators respond to environmental stress signals, aiding in bacterial survival and virulence under challenging conditions.
Crucial for oxidative stress resistance, immune evasion, and regulation of cell surface hydrophobicity and type IV pilus system.
PPK1 is essential for polyphosphate synthesis, affecting motility, biofilm formation, and resistance to external pressures.
The presence of Acinetobacter baumannii is typically assessed by culturing samples taken from the nasopharynx, wounds, or body fluid samples.
Because Acinetobacter baumannii is typically a hospital-acquired infection, sample collection and testing most commonly occur in a hospital and/or clinical setting.
Acinetobacter baumannii is a potentially pathogenic species that is tested in clinical or hospital settings when there is concern for nosocomial infection with this organism. Optimal levels of this bacterium are undetectable.
The presence of elevated levels of Acinetobacter baumannii in cultured tissue or fluid indicates the presence of colonization or an infection with this organism.
Due to increasing antibiotic resistance of Acinetobacter baumannii, selecting the appropriate treatment for an individual is essential.
Treatment decisions will be guided by the individual's potential medication allergies, as well as susceptibility of the organism present to various antibiotic therapies.
Acinetobacter baumannii, the most common strain of Acinetobacter spp. infection, is inherently multidrug-resistant. Few antibiotics currently available are effective against it.
Avoid treating colonization; however, infections require treatment.
Bacterial colonization is defined as the presence and growth of bacteria on or in a host without causing disease or eliciting an immune response. Colonization generally does not trigger an inflammatory response or symptoms.
Colonization often occurs on external surfaces like skin or mucous membranes, and it can be beneficial or neutral to the host (e.g., normal gut flora).
In contrast, an infection is the invasion and multiplication of bacteria in host tissues, causing cellular injury and eliciting an immune response that is ultimately harmful to the host.
Medications to which Acinetobacter is usually sensitive include: [1.]
First-, second-, and third-generation cephalosporins, macrolides, and penicillins generally have little or no activity against Acinetobacter and may predispose to colonization.
Some strains are sensitive to cefepime, ceftazidime, and some combination antibiotics.
Both monotherapy and combination therapy (e.g., amikacin, minocycline, or colistin ± rifampin) have been used successfully.
While combination therapy is often suggested, conclusive data on its superiority in preventing failure or resistance development are lacking. It can be considered for empiric therapy in areas with high antimicrobial resistance rates or for cases where infections are resistant to multiple antibiotic classes.
Acinetobacter baumannii refers to a group of bacteria that are increasingly recognized for their role in causing healthcare-associated infections. These bacteria are known for their resistance to multiple antibiotics, posing significant challenges in clinical settings.
Acinetobacter spp. is a group of gram-negative bacteria commonly found in the environment, particularly in soil and water. They have become significant pathogens in healthcare settings, capable of causing a range of infections, especially in immunocompromised patients.
Acinetobacter baumannii is a member of the Acinetobacter spp. group, and is considered the most virulent.
Acinetobacter baumannii can cause various infections, including:
Acinetobacter baumannii is significant because it is highly resistant to multiple antibiotics, making infections difficult to treat. It can survive on surfaces for extended periods, facilitating its spread within healthcare facilities and leading to outbreaks of infections.
Diagnosis typically involves collecting samples from the site of infection (e.g., sputum, blood, wound swab) and performing laboratory tests, such as cultures and molecular methods, to identify the presence of Acinetobacter baumannii
Symptoms depend on the site of infection but can include:
Treatment is challenging due to antibiotic resistance. Options may include:
Preventive measures include:
Testing for Acinetobacter baumannii provides the opportunity for swift treatment and eradication of this potentially pathogenic organism. It requires an understanding of the prevalence and resistance patterns of these bacteria.
Risk factors include:
Seek medical attention if you experience symptoms of an infection, particularly if you have been hospitalized or have risk factors such as a compromised immune system.
Early diagnosis and appropriate treatment are key to managing Acinetobacter baumannii infections effectively.
[1.] Acinetobacter Medication: Antibiotics. emedicine.medscape.com. https://emedicine.medscape.com/article/236891-medication?form=fpf
[2.] Acinetobacter species - Infectious Disease and Antimicrobial Agents. www.antimicrobe.org. http://www.antimicrobe.org/b71.asp
[3.] Brady MF, Jamal Z, Pervin N. Acinetobacter. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430784/
[4.] Elhosseiny NM, Attia AS. Acinetobacter: an emerging pathogen with a versatile secretome. Emerg Microbes Infect. 2018 Mar 21;7(1):33. doi: 10.1038/s41426-018-0030-4. PMID: 29559620; PMCID: PMC5861075.
[5.] Poirel L, Nordmann P. Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clinical Microbiology and Infection. 2006;12(9):826-836. doi:https://doi.org/10.1111/j.1469-0691.2006.01456.x
[6.] Yao Y, Chen Q, Zhou H. Virulence Factors and Pathogenicity Mechanisms of Acinetobacter baumannii in Respiratory Infectious Diseases. Antibiotics. 2023;12(12):1749. doi:https://doi.org/10.3390/antibiotics12121749