Acinetobacter

Taxobox
color = lightgrey
name = "Acinetobacter"


image_width = 300 px
image_caption = "Acinetobacter baumannii"
regnum = Bacteria
phylum = Proteobacteria
classis = Gammaproteobacteria
ordo = Pseudomonadales
familia = Moraxellaceae
genus = "Acinetobacter"
genus_authority = Brisou & Pr�vot 1954
subdivision_ranks = Species
subdivision = "A. baumannii" "A. calcoaceticus" "A. johnsonii" "A. junii" "A. lwoffii" "A. radioresistens" "A. septicus" "A. schindleri" "A. ursingii"
etc.

"Acinetobacter" is a Gram-negative genus of bacteria belonging to the phylum Proteobacteria. Non-motile, "Acinetobacter" species are oxidase-negative, and occur in pairs under magnification. They are important soil organisms where they contribute to the mineralisation of, for example, aromatic compounds. "Acinetobacter" are an important source of infection in debilitated patients in the hospital.cite book | author = Gerischer U (editor). | title = Acinetobacter Molecular Biology | edition = 1st ed. | publisher = Caister Academic Press | year = 2008 | url=http://www.horizonpress.com/acineto | id = [http://www.horizonpress.com/acineto ISBN 978-1-904455-20-2] ]

Identification

Using FLN, or Fluorescence-Lactose-Denitrification medium, to find the amount of acid produced by metabolism of glucose, different species of bacteria under this genus can be identified.

Description

Microbiology

Species of the genus "Acinetobacter" are strictly aerobic nonfermentative gram-negative bacilli. They show preponderantly a coccobacillary morphology on nonselective agar. Rods predominate in fluid media, especially during early growth.

The morphology of "Acinetobacter spp." can be quite variable in Gram stained human clinical specimens, and cannot be used to differentiate "Acinetobacter" from other common causes of infection.

Most strains of "Acinetobacter", except some of the "A. lwoffii" strain, grow well on MacConkey agar (without salt). Although officially classified as non-lactose fermenting, they are often partially lactose fermenting when grown on MacConkey agar. They are oxidase negative, nonmotile and usually nitrate negative.

Taxonomy

The genus "Acinetobacter" comprises 17 validly named and 14 unnamed (genomic) species.cite book |chapterurl=http://www.horizonpress.com/acineto |author=Dijkshoorn L|chapter=The Diversity of the Genus Acinetobacter | title = Acinetobacter Molecular Biology "(Gerischer U, ed.)| publisher = Caister Academic Press | year = 2008 | id = [http://www.horizonpress.com/acineto ISBN 978-1-904455-20-2] ] Some unrelated (genomic) species have common designations, while some other species seem to be congruent but have different names. The knowledge of the biology or ecology of acinetobacters at species level is limited. This is due to the fact that identification of acinetobacters at species level is difficult. A phenotypic species identification system has been described and a variety of genotypic methods has been explored and applied to investigate the diversity or phylogeny in the genus. These methods include high resolution fingerprinting with AFLP, PCR-RFLP with digestion of PCR amplified sequences, and analysis of various DNA sequences. Of these, AFLP analysis and amplified 16SrRNA ribosomal DNA restriction analysis have been validated with large numbers of strains of all described species. Nucleotide sequence based methods are expected to be the standard for identification in the near future.cite book |chapterurl=http://www.horizonpress.com/acineto |author=Dijkshoorn L|chapter=The Diversity of the Genus Acinetobacter | title = Acinetobacter Molecular Biology "(Gerischer U, ed.)| publisher = Caister Academic Press | year = 2008 | id = [http://www.horizonpress.com/acineto ISBN 978-1-904455-20-2] ]

However, because routine identification in the clinical microbiology laboratory is not (yet) possible, they are divided and grouped into three main complexes:
* "Acinetobacter calcoaceticus-baumanii complex": glucose-oxidising nonhemolytic, (A.baumannii can be identified by OXA-51 typing)
* "Acinetobacter lwoffii": glucose-negative nonhemolytic
* "Acinetobacter haemolyticus": hemolytic

Natural habitat

"Acinetobacter spp" are widely distributed in nature. They are able to survive on various surfaces (both moist and dry) in the hospital environment, thereby being an important source of infection in debilitated patients. Occasional strains are isolated from foodstuffs and some are able to survive on various medical equipment and even on healthy human skin.

In drinking water, "Acinetobacter" have been shown to aggregate bacteria who otherwise do not form aggregates.

Clinical significance

"Acinetobacter" species are generally considered nonpathogenic to healthy individuals. However, several species persist in hospital environments and cause severe, life-threatening infections in compromised patients.cite book | author = Gerischer U (editor). | title = Acinetobacter Molecular Biology | edition = 1st ed. | publisher = Caister Academic Press | year = 2008 | url=http://www.horizonpress.com/acineto | id = [http://www.horizonpress.com/acineto ISBN 978-1-904455-20-2] ] The spectrum of antibiotic resistances of these organisms together with their survival capabilities make them a threat to hospitals as documented by recurring outbreaks both in highly developed countries and elsewhere. An important factor for their pathogenic potential is probably an efficient means of horizontal gene transfer even though such a mechanism has so far only been observed and analyzed in "Acinetobacter baylyi", a species that lives in the soil and has never been associated with infections.cite book | author = Gerischer U (editor). | title = Acinetobacter Molecular Biology | edition = 1st ed. | publisher = Caister Academic Press | year = 2008 | url=http://www.horizonpress.com/acineto | id = [http://www.horizonpress.com/acineto ISBN 978-1-904455-20-2] ]

Most infections occur in immunocompromised individuals, and the strain "A. baumannii" is the second most commonly isolated nonfermenting bacteria in human specimens.

"Acinetobacter" is frequently isolated in nosocomial infections and is especially prevalent in intensive care units, where both sporadic cases as well as epidemic and endemic occurrence is common. "A. baumannii" is a frequent cause of nosocomial pneumonia, especially of "late-onset" ventilator associated pneumonia. It can cause various other infections including skin and wound infections, bacteremia, and meningitis, but "A. lwoffi" is mostly responsible for the latter. "A. baumannii" can survive on the human skin or dry surfaces for weeks.

Since the start of the Iraq War, over 700 U.S. soldiers have been infected or colonized by "A. baumannii". Four civilians undergoing treatment for serious illnesses at Walter Reed Army Medical Center in Washington, D.C., contracted "A. baumannii" infections and died. At Landstuhl Regional Medical Center, a U.S. military hospital in Germany, another civilian under treatment, a 63-year-old German woman, contracted the same strain of "A. baumannii" infecting troops in the facility and also died. These infections appear to have been hospital acquired. [http://www.wired.com/wired/archive/15.02/enemy.html]

Treatment

"Acinetobacter" species are innately resistant to many classes of antibiotics, including penicillin, chloramphenicol, and often aminoglycosides. Resistance to fluoroquinolones has been reported during therapy and this has also resulted in increased resistance to other drug classes mediated through active drug efflux. A dramatic increase in antibiotic resistance in "Acinetobacter" strains has been reported by the CDC and the carbapenems are recognised as the gold-standard and/or treatment of last resort. Rather worryingly is an increase in resistance to the carbapenems which leaves very little treatment option although there some success reported with polymyxin B as well as the use of novel combinations of antibiotics.cite journal | author = Rahal J | title = Novel antibiotic combinations against infections with almost completely resistant "Pseudomonas aeruginosa" and "Acinetobacter" species | journal = Clin Infect Dis | volume = 43 Suppl 2 | issue = | pages = S95–9 | year = 2006 | pmid = 16894522 | doi = 10.1086/504486] Acinetobacter species are unusual in that they are sensitive to sulbactam; sulbactam is most commonly used to inhibit bacterial beta-lactamase, but this is an example of the antibacterial property of sulbactam itself. [cite journal | author=Wood GC, Hanes SD, Croce MA, Fabian TC, Bougher BA. | title=Comparison of ampicillin-sulbactam and imipenem-cilastin for the treatment of "Acinetobacter" ventilator-associated pneumonia | journal=Clin Infect Dis | year=2002 | volume=34 | pages=1425–30 | doi=10.1086/340055]

In November, 2004, the CDC reported an increasing number of "A. baumannii" bloodstream infections in patients at military medical facilities in which service members injured in the Iraq/Kuwait region during Operation Iraqi Freedom (OIF) and in Afghanistan during Operation Enduring Freedom (OEF) were treated.cite journal | author = | title = "Acinetobacter baumannii" infections among patients at military medical facilities treating injured U.S. service members, 2002-2004 | journal = MMWR Morb Mortal Wkly Rep | volume = 53 | issue = 45 | pages = 1063–6 | year = 2004|pmid = 15549020] Most of these were multidrug-resistant. Among one set of isolates from Walter Reed Army Medical Center, 13 (35%) were susceptible to imipenem only, and two (4%) were resistant to all drugs tested. One antimicrobial agent, colistin (polymyxin E), has been used to treat infections with multidrug-resistant A. baumannii;" however, antimicrobial susceptibility testing for colistin was not performed on isolates described in this report. Because "A. baumannii" can survive on dry surfaces for up to 20 days, they pose a high risk of spread and contamination in hospitals, potentially putting immune-compromised and other patients at risk for drug resistant infections that are often fatal and generally expensive to treat.

Identification

Schreckenberger PC, Daneshvar MI, Weyant RS, Hollis DG. Acinetobacter, Achromobacter, Chryseobacterium, Moraxella, and Other Nonfermentative Gram-Negative Rods. In: Murray PR, et al. (Eds.) Manual of Clinical Microbiology. 8 Ed. (2003) ASM Press, Washington DC, pp 749-779

Risk factors

* Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jimenez-Jimenez FJ, Perez-Paredes C, Barrero-Almodovar AE, Gili-Miner M. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis. 2001 October 1;33(7):939-46.

* Chen CH, Young TG, Huang CC. Predictive biomarkers for drug-resistant Acinetobacter baumannii isolates with bla(TEM-1), AmpC-type bla and integrase 1 genotypes. J Microbiol Immunol Infect. 2006 Oct;39(5):372-9. PMID 17066198

* 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 Sep;60(9):351-60. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16940684&query_hl=2&itool=pubmed_DocSum PMID 16940684]

* Robenshtok E, Paul M, Leibovici L, Fraser A, Pitlik S, Ostfeld I, Samra Z, Perez S, Lev B, Weinberger M. The significance of Acinetobacter baumannii bacteraemia compared with Klebsiella pneumoniae bacteraemia: risk factors and outcomes. J Hosp Infect. 2006 Nov;64(3):282-7. Epub 2006 August 22. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16930770&query_hl=2&itool=pubmed_DocSum PMID 16930770]

Resistance

"General, ICU"

* Global / Large Area
** Waites KB, Duffy LB, Dowzicky MJ. Antimicrobial susceptibility among pathogens collected from hospitalized patients in the United States and in vitro activity of tigecycline, a new glycylcycline antimicrobial. Antimicrob Agents Chemother. 2006 Oct;50(10):3479-84. [PMID 17005838]
** Jones ME, Draghi DC, Thornsberry C, Karlowsky JA, Sahm DF, Wenzel RP. Emerging resistance among bacterial pathogens in the intensive care unit - A European and North American Surveillance study (2000-2002). Ann Clin Microbiol Antimicrob. 2004 July 29;3:14.
** Clark NM, Patterson J, Lynch JP 3rd. Antimicrobial resistance among gram-negative organisms in the intensive care unit. Curr Opin Crit Care. 2003 Oct;9(5):413-23.

* Limited Region / One Hospital
** Bayram A, Balci I. Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey. BMC Infect Dis. 2006 October 25;6:155. PMID 17064415
** Dobrewski R, Savov E, Bernards AT, van den Barselaar M, Nordmann P, van den Broek PJ, Dijkshoorn L. Genotypic diversity and antibiotic susceptibility of Acinetobacter baumannii isolates in a Bulgarian hospital. Clin Microbiol Infect. 2006 Nov;12(11):1135-7. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17002615&query_hl=2&itool=pubmed_DocSum PMID 17002615]

"Acinetobacter"

* MDR
** Falagas ME, Koletsi PK, Bliziotis IA. The diversity of definitions of multidrug-resistant (MDR) and pandrug-resistant (PDR) "Acinetobacter baumannii" and "Pseudomonas aeruginosa". J Med Microbiol. 2006 Dec;55 (Pt 12):1619-29. PMID 17108263
** Nseir S, Di Pompeo C, Cavestri B, Jozefowicz E, Nyunga M, Soubrier S, Roussel-Delvallez M, Saulnier F, Mathieu D, Durocher A. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: Prevalence, risk factors, and outcome. Crit Care Med. 2006 Dec;34(12):2959-66. PMID 17012911
** Hujer KM, Hujer AM, Hulten EA, Bajaksouzian S, Adams JM, Donskey CJ, Ecker DJ, Massire C, Eshoo MW, Sampath R, Thomson JM, Rather PN, Craft DW, Fishbain JT, Ewell AJ, Jacobs MR, Paterson DL, Bonomo RA. Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob Agents Chemother. 2006 Dec;50(12):4114-23. Epub 2006 September 25. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17000742&query_hl=2&itool=pubmed_DocSum PMID 17000742]
** Hsueh PR, Teng LJ, Chen CY, Chen WH, Yu CJ, Ho SW, et al. Pandrug-resistant Acinetobacter baumannii causing nosocomial infections in a university hospital, Taiwan. Emerg Infect Dis 2002 Aug;8. PMID 12141969 Full text available from: http://www.cdc.gov/ncidod/EID/vol8no8/02-0014.htm
** Mahgoub S, Ahmed J, Glatt AE. Underlying characteristics of patients harboring highly resistant Acinetobacter baumannii. Am J Infect Control. 2002 Nov;30(7):386-90.

* Carbapenem Resistance
** Coelho JM, Turton JF, Kaufmann ME, Glover J, Woodford N, Warner M, Palepou MF, Pike R, Pitt TL, Patel BC, Livermore DM. Occurrence of carbapenem-resistant Acinetobacter baumannii clones at multiple hospitals in London and Southeast England. J Clin Microbiol. 2006 Oct;44(10):3623-7. PMID 17021090
** Bogaerts P, Naas T, Wybo I, Bauraing C, Soetens O, Pierard D, Nordmann P, Glupczynski Y. Outbreak of infection by carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-58 in Belgium. J Clin Microbiol. 2006 Nov;44(11):4189-92. Epub 2006 September 6. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16957031&query_hl=2&itool=pubmed_DocSum PMID 16957031]
** Jeong SH, Bae IK, Park KO, An YJ, Sohn SG, Jang SJ, Sung KH, Yang KS, Lee K, Young D, Lee SH. Outbreaks of imipenem-resistant Acinetobacter baumannii producing carbapenemases in Korea. J Microbiol. 2006 Aug;44(4):423-31. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16953178&query_hl=2&itool=pubmed_DocSum PMID 16953178]
** Cisneros JM, Rodriguez-Bano J, Fernandez-Cuenca F, Ribera A, Vila J, Pascual A, Martinez-Martinez L, Bou G, Pachon J; Spanish Group for Nosocomial Infection (GEIH) for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Risk-factors for the acquisition of imipenem-resistant Acinetobacter baumannii in Spain: a nationwide study. Clin Microbiol Infect. 2005 Nov;11(11):874-9.
** Lee SO, Kim NJ, Choi SH, Hyong Kim T, Chung JW, Woo JH, Ryu J, Kim YS. Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case-control study. Antimicrob Agents Chemother. 2004 Jan;48(1):224-8. Erratum in: Antimicrob Agents Chemother. 2004 Mar;48(3):1070.

* Cephalosporin Resistance
** Lee K, Lim CH, Cho JH, Lee WG, Uh Y, Kim HJ, Yong D, Chong Y; KONSAR Group. High prevalence of ceftazidime-resistant Klebsiella pneumoniae and increase of imipenem-resistant Pseudomonas aeruginosa and Acinetobacter spp. in Korea: a KONSAR program in 2004. Yonsei Med J. 2006 October 31;47(5):634-45. PMID 17066507

Therapy

"Colistin"

Montero A, Ariza J, Corbella X, Domenech A, Cabellos C, Ayats J, Tubau F, Ardanuy C, Gudiol F. Efficacy of colistin versus beta-lactams, aminoglycosides, and rifampin as monotherapy in a mouse model of pneumonia caused by multiresistant Acinetobacter baumannii. Antimicrob Agents Chemother. 2002 Jun;46(6):1946-52.

Reports suggest that this bacteria is susceptible to phage therapy. [ [http://cat.inist.fr/?aModele=afficheN&cpsidt=17212906 Bacteriophage therapy: a revitalized therapy against bacterial infectious diseases] ] A phage directed against "Acinetobacter" showed a remarkable lytic activity both "in vitro" and "in vivo": as few as 100 pfu of phage protected mice against "Acinetobacter".cite book |chapterurl=http://www.horizonpress.com/phage |author=Brussow H|chapter=Phage Therapy: The Western Perspective | title = Bacteriophage: Genetics and Molecular Biology "(Mc Grath S and van Sinderen D, ed.)| publisher = Caister Academic Press | year = 2007 | id = [http://www.horizonpress.com/phage ISBN 978-1-904455-14-1] ]

Biotechnology

Many of the characteristics of "Acinetobacter" ecology, taxonomy, physiology and genetics point to the possibility of exploiting its unique features for future applications. "Acinetobacter" strains are often ubiquitous, exhibit metabolic versatility, are robust and some provide convenient systems for modern molecular genetic manipulation and subsequent product engineering. These characteristics are being exploited in various biotechnological applications including biodegradation and bioremediation, novel lipid and peptide production, enzyme engineering, biosurfactant and biopolymer production and engineering of novel derivatives of these products. It is anticipated that progress in these fields will broaden the range of applications of "Acinetobacter" for modern biotechnology.cite book |chapterurl=http://www.horizonpress.com/acineto |author=Gutnick D|chapter=Potential Application of Acinetobacter in Biotechnology | title = Acinetobacter Molecular Biology "(Gerischer U, ed.)| publisher = Caister Academic Press | year = 2008 | id = [http://www.horizonpress.com/acineto ISBN 978-1-904455-20-2] ]

References

External links

* [http://www.tufts.edu/med/apua/News/military.html Alliance for the Prudent Use of Antibiotics]
* [http://cmr.tigr.org/tigr-scripts/CMR/GenomePage.cgi?org=ntas01 "Acinetobacter" sp. ADP1 Genome Page]