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Infectious Diseases > MEDICAL TOPICS
Acinetobacter
Article Last Updated: May 8, 2007
AUTHOR AND EDITOR INFORMATION
Section 1 of 10  
Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Editors: Charles S Levy, MD, Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine; Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital; Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Author and Editor Disclosure
Synonyms and related keywords:
Acinetobacter baumannii, A baumannii, Acinetobacter lwoffi, A lwoffi, Acinetobacter pneumonia, Mima polymorpha, nosocomial pneumonia, continuous ambulatory peritoneal dialysis, CAPD, catheter-associated bacteruria, Acinetobacter urinary tract infection, UTI, URTI
Background
Acinetobacter baumannii is a pleomorphic aerobic gram-negative bacillus (similar in appearance to Haemophilus influenzae on Gram stain) commonly isolated from the hospital environment and hospitalized patients. A baumannii is a water organism and preferentially colonizes aquatic environments. This organism is often cultured from hospitalized patients' sputum or respiratory secretions, wounds, and urine. Acinetobacter commonly colonizes irrigating solutions and intravenous solutions. Acinetobacter is an organism of low virulence, but it is capable of causing infection. Most Acinetobacter isolates recovered from hospitalized patients, particularly those recovered from respiratory secretions and urine, represent colonization rather than infection. Acinetobacter infections are uncommon, but, when they occur, they usually involve organ systems with a high fluid content (eg, respiratory tract, CSF, peritoneal fluid, urinary tract), manifesting as nosocomial pneumonia, infections associated with continuous ambulatory peritoneal dialysis (CAPD), or catheter-associated bacteruria. The presence of the organism in respiratory secretions in intubated patients nearly always represents colonization. Acinetobacter pneumonias occur in outbreaks and are usually associated with colonized respiratory support equipment or fluids. Nosocomial meningitis may occur in colonized neurosurgical patients with external ventricular drainage tubes. A baumannii is a multiresistant aerobic gram-negative bacillus sensitive to relatively few antibiotics. Multidrug-resistant Acinetobacter is not a new or emerging phenomenon, but A baumannii has always been an organism inherently resistant to multiple antibiotics.
Pathophysiology
In the uncommon situations in which Acinetobacter causes actual infection, the pathological changes that occur depend on the organ system involved. The pathological changes, as observed in patients with pneumonia, are indistinguishable from those caused by other noncavitating aerobic gram-negative bacilli that cause nosocomial pneumonias. Similarly, Acinetobacter urinary tract infections are clinically indistinguishable from catheter-associated bacteremias caused by other aerobic gram-negative bacilli.
Frequency
International
Acinetobacter is a common colonizer of patients in the intensive care setting. Acinetobacter colonization is particularly common in patients who are intubated and in those who have multiple intravenous lines or monitoring devices, surgical drains, or indwelling urinary catheters. Acinetobacter infections are rare and occur almost exclusively in hospitalized patients.
Mortality/Morbidity
- Although Acinetobacter primarily is a colonizer in the hospital environment, occasionally it causes infection. Mortality and morbidity resulting from A baumannii infection relate to the underlying cardiopulmonary immune status of the host rather than the inherent virulence of the organism.
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- Patients who are very ill with multisystem disease have increased mortality and morbidity rates resulting from their underlying illness rather than the superimposed infection with Acinetobacter.
Race
No racial predilection is known.
Sex
No sex predilection is known.
Age
No age predilection exists.
History
- Prolonged hospitalization or antibiotic therapy predisposes to Acinetobacter colonization.
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- Patients with Acinetobacter pneumonias occurring in the context of an outbreak in the intensive care unit (ICU) generally have a history of preceding contact with respiratory support monitors or equipment.
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- Patients with Acinetobacter colonization often have a history of prolonged hospitalization or antimicrobial therapy (with antibiotics that have little or no activity against Acinetobacter).
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Physical
- Because colonization is the rule and infection is the exception, physical findings are not present in colonized patients.
- Patients with Acinetobacter infection have signs and symptoms related to the organ system involved, ie, wound infection, episodic outbreaks of nosocomial pneumonia, CAPD-associated peritonitis, nosocomial meningitis, or catheter-associated bacteruria.
- The following is summarized from an article by Go and Cunha (1999):
- Acinetobacter commonly colonizes skin, oropharynx secretions, respiratory secretions, and urine.
- Acinetobacter uncommonly colonizes the gastrointestinal tract and is associated with nosocomial pneumonias (which usually occur as outbreaks), bacteremias, and wound infections.
- Acinetobacter infection is rarely associated with meningitis, endocarditis (native valve infective endocarditis and prosthetic valve endocarditis), peritonitis, urinary tract infections, community-acquired pneumonia, and cholangitis.
Causes
- Antimicrobial therapy using agents with little or no activity against Acinetobacter predisposes to Acinetobacter colonization.
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- Residency in an ICU, particularly in the presence of other patients who are colonized with Acinetobacter, predisposes patients to colonization.
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Other Problems to be Considered
The main differential diagnostic problem with Acinetobacter is to differentiate colonization from infection.
In the presence of pulmonary infiltrates in ICU patients, CAPD-associated peritonitis, meningitis, wound infection, or catheter-associated bacteruria, the differential diagnosis includes other aerobic gram-negative bacilli that colonize or infect these fluids, ie, Enterobacter species, Stenotrophomonas maltophilia, Burkholderia cepacia, Pseudomonas aeruginosa, Flavobacterium meningosepticum, and Serratia marcescens.
Because Acinetobacter is predominantly a colonizing organism, the burden of proof is on the clinician to demonstrate its pathogenic role in a given situation.
Lab Studies
- A complete blood cell (CBC) count is nonspecific, and leukocytosis, even with a left shift, cannot be used to differentiate infection from noninfection or bacterial infection from nonbacterial infection. The CBC count cannot be used to differentiate infection from colonization.
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- Culture of the appropriate body fluid that is properly transported, plated, and incubated grows A baumannii.
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- Recovery of the organism from a nonsterile body site (eg, endotracheal secretions, urine in patient with Foley catheter) does not indicate or imply an infectious pathogenic role.
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- In outbreaks, Acinetobacter may be easily cultured from monitoring devices or biological fluids from multiple patients as part of an epidemiological investigation.
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Imaging Studies
- A chest radiograph and/or CT scan or MRI of the chest may be useful in defining the extent of a nosocomial pneumonia caused by any organism.
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Other Tests
- Tests are related to the organ system involved.
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Procedures
- CSF culture is necessary if shunt-associated or ventricular drain–associated meningitis is suspected.
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Histologic Findings
Histological changes caused by Acinetobacter infection are indistinguishable from those caused by all aerobic gram-negative bacilli, except those associated with vessel invasion and cavitation, eg, Klebsiella pneumoniae and P aeruginosa.
Medical Care
Initiate supportive care, depending on the organ system involved.
Surgical Care
Colonized or infected lines, drains, shunts, or other devices should be removed or replaced as required.
Consultations
A consultation with an infectious disease specialist is advised to differentiate colonization from infection and for antibiotic recommendations if infection is present.
A baumannii is intrinsically multidrug resistant. Relatively few antibiotics are active against this organism. While colonization should not be treated, infection should.
As summarized by Go and Cunha (1999), medications to which Acinetobacter is usually sensitive include the following:
- Meropenem
- Colistin
- Polymyxin B
- Amikacin
- Rifampin
- Minocycline
- Tigecycline
In general, first-, second-, and third-generation cephalosporins, macrolides, and penicillins have little or no anti-Acinetobacter activity, and their use may predispose to Acinetobacter colonization.
Drug Category: Antibiotics
Empiric antimicrobial therapy should include one of the agents listed below.
| Drug Name | Colistimethate sodium (Coly-Mycin M) |
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| Description | Hydrolyzed to colistin, which acts as cationic detergent that can damage bacterial cytoplasmic membrane, causing leaking of intracellular substances and cell death. |
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| Adult Dose | 2.5-5 mg/kg/d IV/IM divided bid/qid, depending on severity of infection |
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| Pediatric Dose | Administer as in adults |
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| Contraindications | Documented hypersensitivity; infections caused by Proteus or Neisseria species |
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| Interactions | Concurrent use with aminoglycosides may increase risk of respiratory paralysis and renal dysfunction; concurrent administration with cephalothin may increase risk of renal dysfunction; colistin may enhance neuromuscular blockade of nondepolaizing muscle relaxants |
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| Pregnancy | C - Safety for use during pregnancy has not been established.
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| Precautions | Respiratory arrest; decreased urine output or increased BUN or serum creatinine levels; paresthesia; tingling of extremities or tongue; generalized itching or urticaria; drug fever; GI upset; vertigo; slurring of speech may occur |
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| Drug Name | Meropenem (Merrem) |
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| Description | Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-positive and gram-negative bacteria. Has slightly increased activity against gram-negative bacteria and slightly decreased activity against staphylococci and streptococci compared with imipenem. |
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| Adult Dose | 1 g IV q8h |
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| Pediatric Dose | >10 years: Administer as in adults
<10 years: Not established |
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| Contraindications | Documented hypersensitivity; first trimester of pregnancy |
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| Interactions | Probenecid may inhibit renal excretion of meropenem, increasing meropenem levels |
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| Pregnancy | B - Usually safe but benefits must outweigh the risks.
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| Precautions | Adjust dose in renal impairment; pseudomembranous colitis and thrombocytopenia may occur, which require immediate discontinuation |
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| Drug Name | Amikacin (Amikin) |
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| Description | Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Effective against P aeruginosa.
Use patient's IBW for dosage calculation. The same principles of drug monitoring for gentamicin apply to amikacin. |
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| Adult Dose | 15 mg/kg/d IV/IM divided bid/tid; not to exceed 1.5 g/d regardless of higher BW |
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| Pediatric Dose | Administer as in adults |
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| Contraindications | Documented hypersensitivity |
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| Interactions | Coadministration with other aminoglycosides, penicillins, cephalosporins, and amphotericin B increases nephrotoxicity; enhances effects of neuromuscular-blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics |
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| Pregnancy | D - Unsafe in pregnancy
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| Precautions | Not intended for long-term therapy; caution in patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission |
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| Drug Name | Polymyxin B (Poly-RX) |
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| Description | Binds to phospholipids, alters permeability, and damages bacterial cytoplasmic membrane. |
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| Adult Dose | 15,000-20,000 U/kg/d IV divided q12h |
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| Pediatric Dose | <2 years: Not established
>2 years: Administer as in adults |
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| Contraindications | Documented hypersensitivity to drug or components of formulation; concurrent use of neuromuscular blockers |
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| Interactions | May increase or prolong effect of neuromuscular-blocking agents |
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| Pregnancy | B - Usually safe but benefits must outweigh the risks.
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| Precautions | Prolonged use of antibiotics or repeated therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms |
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| Drug Name | Tigecycline (Tygacil) |
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| Description | A glycylcycline antibiotic that is structurally similar to tetracycline antibiotics. Inhibits bacterial protein translation by binding to 30S ribosomal subunit and blocks entry of amino-acyl tRNA molecules in ribosome A site. Indicated for complicated skin and skin structure infections caused by E coli, E faecalis (vancomycin-susceptible isolates only), S aureus (methicillin-susceptible and -resistant isolates), S agalactiae, S anginosus group (includes S anginosus, S intermedius, and S constellatus), S pyogenes, and B fragilis. |
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| Adult Dose | Infuse each dose over 30-60 min
100 mg IV once, then 50 mg IV q12h
Severe hepatic impairment (ie, Child Pugh class C): 100 mg IV once, then 25 mg IV q12h |
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| Pediatric Dose | <18 years: Not established
>18 years: Administer as in adults |
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| Contraindications | Documented hypersensitivity |
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| Interactions | Coadministration decreases warfarin clearance and increases warfarin Cmax and AUC (monitor aPTT and INR); coadministration of antibiotics with oral contraceptives may decrease contraceptive effect |
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| Pregnancy | D - Unsafe in pregnancy
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| Precautions | Caution in severe hepatic impairment (reduce dose); may adversely effect tooth development; may permit clostridial overgrowth, resulting in antibiotic-associated colitis; may have adverse effects similar to tetracyclines (eg, photosensitivity, pseudotumor cerebri, pancreatitis, antianabolic action) |
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Further Inpatient Care
- Precautions should be taken to prevent colonized patients from colonizing other patients, particularly in the ICU.
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Deterrence/Prevention
- Although colonization rarely results in infection, colonization does precede infection. Colonization in one patient may result in infection in another patient. For these reasons, every attempt should be made to isolate patients who are colonized with Acinetobacter in order to prevent other patients from becoming colonized.
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Prognosis
- Prognosis depends on the underlying health of the host and the extent of organ involvement; it is the same as for other aerobic gram-negative bacillary infections.
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Medical/Legal Pitfalls
- Clinicians should be careful not to treat A baumannii colonization.
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- Bernards AT, Harinck HI, Dijkshoorn L, et al. Persistent Acinetobacter baumannii? Look inside your medical equipment. Infect Control Hosp Epidemiol. Nov 2004;25(11):1002-4. [Medline].
- Bukhary Z, Mahmood W, Al-Khani A, Al-Abdely HM. Treatment of nosocomial meningitis due to a multidrug resistant Acinetobacter baumannii with intraventricular colistin. Saudi Med J. Apr 2005;26(4):656-8. [Medline].
- Buxton AE, Anderson RL, Werdegar D. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus. Epidemiologic characteristics. Am J Med. Sep 1978;65(3):507-13. [Medline].
- Castle M, Tenney JH, Weinstein MP. Outbreak of a multiply resistant Acinetobacter in a surgical intensive care unit: epidemiology and control. Heart Lung. Jul-Aug 1978;7(4):641-4. [Medline].
- Cefai C, Richards J, Gould FK. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect. Feb 1990;15(2):177-82. [Medline].
- Chen HP, Lai CH, Chan YJ, et al. Clinical significance of Acinetobacter species isolated from cerebrospinal fluid. Scand J Infect Dis. 2005;37(9):669-75. [Medline].
- Cisneros JM, Rodríguez-Baño J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect. Nov 2002;8(11):687-93. [Medline].
- Cunha BA. Pseudoinfections and pseudo-outbreaks. In: Mayhall G, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 1999.
- Cunha BA, Klein NC. Pseudoinfections: A review. Infect Dis Clin Pract. 1995;4:95-103.
- Cunha BA, Klimek JJ, Gracewski J. A common source outbreak of Acinetobacter pulmonary infections traced to Wright respirometers. Postgrad Med J. Mar 1980;56(653):169-72. [Medline].
- Cunha BA, Visvalingam B, Yannelli B. Pseudomeningitis caused by Acinetobacter baumannii. Am J Infect Control. Apr 1999;27(2):179-81. [Medline].
- Cunha BA. Infections caused by non-fermentative aerobic gram-negative bacilli in the critical care unit. Antibiotics for Clinicians. 2000;4(S1):11-16.
- Cunha BA. Antibiotic Essentials. 5th ed. Royal Oak, Mich: Physicians Press; 2006:2006.
- Dijkshoorn L, van Dalen R, van Ooyen A. Endemic Acinetobacter in intensive care units: epidemiology and clinical impact. J Clin Pathol. Jun 1993;46(6):533-6. [Medline].
- Drago L, De Vecchi E, Nicola L, et al. Activity of levofloxacin and ciprofloxacin in combination with cefepime, ceftazidime, imipenem, piperacillin-tazobactam and amikacin against different Pseudomonas aeruginosa phenotypes and Acinetobacter spp. Chemotherapy. Oct 2004;50(4):202-10. [Medline].
- Falagas ME, Kasiakou SK, Michalopoulos A. Antimicrobial resistance of Acinetobacter spp. in Europe. Clin Microbiol Infect. Dec 2004;10(12):1106-7. [Medline].
- Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. Mar 1 2006;42(5):692-9. [Medline].
- French GL, Casewell MW, Roncoroni AJ. A hospital outbreak of antibiotic-resistant Acinetobacter anitratus: epidemiology and control. J Hosp Infect. Jun 1980;1(2):125-31. [Medline].
- Fulnecky EJ, Wright D, Scheld WM, et al. Amikacin and colistin for treatment of Acinetobacter baumannii meningitis. J Infect. Dec 2005;51(5):e249-51. [Medline].
- Getchell-White SI, Donowitz LG, Groschel DH. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol. Sep 1989;10(9):402-7. [Medline].
- Go CH, Joseph T, Cunha BA. Acinetobacter baumannii line-associated infection. Heart Lung. May-Jun 2000;29(3):222-4. [Medline].
- Go J, Cunha BA. Acinetobacter baumannii: Infection control implications. Infect Dis Pract. 1999;23:65-68.
- Haddad FA, Van Horn K, Carbonaro C, et al. Evaluation of antibiotic combinations against multidrug-resistant Acinetobacter baumannii using the E-test. Eur J Clin Microbiol Infect Dis. Aug 2005;24(8):577-9. [Medline].
- Hartstein AI, Rashad AL, Liebler JM. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med. Nov 1988;85(5):624-31. [Medline].
- Irwin RS, Demers RR, Pratter MR. An outbreak of Acinetobacter infection associated with the use of a ventilator spirometer. Respir Care. Feb 1980;25(2):232-7. [Medline].
- Kasiakou SK, Fragoulis K, Tzagarakis G, et al. Cure of multidrug-resistant Acinetobacter baumannii fixation device-related orthopedic infections in two patients with intravenous colistin. Microb Drug Resist. 2005;11(3):287-9. [Medline].
- Kelkar R, Gordon SM, Giri N. Epidemic iatrogenic Acinetobacter spp. meningitis following administration of intrathecal methotrexate. J Hosp Infect. Oct 1989;14(3):233-43. [Medline].
- Lee CM, Lim HK, Liu CP, Tseng HK. Treatment of pan-drug resistant Acinetobacter baumannii. Scand J Infect Dis. 2005;37(3):195-9. [Medline].
- Marroni M, Pasquarella C, Agodi A, et al. Clonal spread of Acinetobacter baumannii in a general intensive care unit. Ann Ig. Jan-Apr 2004;16(1-2):95-102. [Medline].
- Minnaganti VR, Cunha BA. Acinetobacter baumannii-associated arterial line infection. Am J Infect Control. Oct 2000;28(5):376-7. [Medline].
- Montero A, Corbella X, Ariza J. Clinical relevance of Acinetobacter baumannii ventilator-associated pneumonia. Crit Care Med. Oct 2003;31(10):2557-9. [Medline].
- Motaouakkil S, Charra B, Hachimi A, et al. Colistin and rifampicin in the treatment of nosocomial infections from multiresistant Acinetobacter baumannii. J Infect. Oct 2006;53(4):274-8. [Medline].
- Murray CK, Hospenthal DR. Treatment of multidrug resistant Acinetobacter. Curr Opin Infect Dis. Dec 2005;18(6):502-6. [Medline].
- Nguyen MH, Harris SP, Muder RR. Antibiotic-resistant Acinetobacter meningitis in neurosurgical patients. Neurosurgery. Nov 1994;35(5):851-5; discussion 855. [Medline].
- Pachón-Ibáñez ME, Jiménez-Mejías ME, Pichardo C, et al. Activity of tigecycline (GAR-936) against Acinetobacter baumannii strains, including those resistant to imipenem. Antimicrob Agents Chemother. Nov 2004;48(11):4479-81. [Medline].
- Patterson JE, Vecchio J, Pantelick EL. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med. Nov 1991;91(5):479-83. [Medline].
- Peacock JE, Sorrell L, Sottile FD. Nosocomial respiratory tract colonization and infection with aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus: epidemiologic characteristics and clinical significance. Infect Control Hosp Epidemiol. Jul 1988;9(7):302-8. [Medline].
- Petrosillo N, Chinello P, Proietti MF, et al. Combined colistin and rifampicin therapy for carbapenem-resistant Acinetobacter baumannii infections: clinical outcome and adverse events. Clin Microbiol Infect. Aug 2005;11(8):682-3. [Medline].
- Pimentel JD, Low J, Styles K, et al. Control of an outbreak of multi-drug-resistant Acinetobacter baumannii in an intensive care unit and a surgical ward. J Hosp Infect. Mar 2005;59(3):249-53. [Medline].
- Ristuccia PA, Cunha BA. Acinetobacter. Infect Control. Jul-Aug 1983;4(4):226-9. [Medline].
- Rodríguez-Baño J, Cisneros JM, Fernández-Cuenca F, et al. Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals. Infect Control Hosp Epidemiol. Oct 2004;25(10):819-24. [Medline].
- Seifert H, Baginski R, Schulze A. Antimicrobial susceptibility of Acinetobacter species. Antimicrob Agents Chemother. Apr 1993;37(4):750-3. [Medline].
- Taccone FS, Rodriguez-Villalobos H, De Backer D, et al. Successful treatment of septic shock due to pan-resistant Acinetobacter baumannii using combined antimicrobial therapy including tigecycline. Eur J Clin Microbiol Infect Dis. Apr 2006;25(4):257-60. [Medline].
- Ullman RF, Schoch PE, Cunha BA. Pseudomeningitis due to Acinetobacter CDC Group VE-1 organisms. Clin Microbiol Newslett. 1988;10:6-8.
- Wareham DW, Bean DC. In vitro activities of polymyxin B, imipenem, and rifampin against multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother. Feb 2006;50(2):825; author reply 825-6. [Medline].
- Vandenbroucke-Grauls CM, Kerver AJ, Rommes JH. Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis. Aug 1988;7(4):485-9. [Medline].
- Wood GC, Hanes SD, Boucher BA, et al. Tetracyclines for treating multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia. Intensive Care Med. Nov 2003;29(11):2072-6. [Medline].
- Wood CA, Reboli AC. Infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis. Dec 1993;168(6):1602-3. [Medline].
- Wood GC, Hanes SD, Boucher BA, et al. Tetracyclines for treating multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia. Intensive Care Med. Nov 2003;29(11):2072-6. [Medline].
Acinetobacter excerpt Article Last Updated: May 8, 2007
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