Acinetobacter: Disease, Properties, and Resistance

Acinetobacter is a group of bacteria commonly found in soil, water and dry environments.   Acinetobacter poses very little risk to immune-competent people and the infections are mainly confined in healthcare settings housing very ill patients. People with weakened immune system are susceptible to infections with Acinetobacter. They acquire Acinetobacter infections by person-to-person contact or contact with contaminated surfaces.

Immunocompromised patients i.e. people who have weakened immune systems, chronic lung disease, or diabetes are susceptible to this infection. Very ill patients in ventilator, those with prolonged hospital stay, person having invasive devices like urinary catheters are at greater risk of Acinetobacter infections.  Outbreaks of Acinetobacter infections typically occur in intensive care units (ICU).

Acinetobacter can live on the skin and may survive in the environment/inanimate surfaces for several days. Acinetobacter is associated with skin colonization of hospital personnel and may also “colonize” or live in a patient without causing infection or symptoms, especially in tracheostomy sites or open wounds.

Diseases:

While there are many species of Acinetobacter and all can cause human disease, Acinetobacter baumannii for about 80% of reported infections. Acinetobacter causes a variety of diseases, ranging from pneumonia to serious blood or wound infections, and the symptoms vary depending on the disease.  It is an important cause of ventilator-associated pneumonia and catheter-related bacteremia.

Biochemical Properties:

Acinetobacter was identified by Gram staining, cell and colony morphology, positive catalase test, negative oxidase test and absence of motility.

  1. Gram Staining: Gram negative cocci or coccobacilli
  2. Oxygen requirement: Strictly aerobic
  3. Growth requirements: Non-fastidious
  4. Glucose fermentation: Non fermentative
  5. Motility: Negative
  6. Catalase Test: Positive (+ve)
  7. Oxidase Test: Negative (-ve)
  8. Citrate Test: Positive (+ve) some species may not give positive citrate utilization test.
  9. Nitrate Reducation Test: Negative (-ve)
  10. Hemolysis: Negative except. A.haemolyticus
  11. Chloramphenicol: Resistant
  12. Arginine Hydrolysis: +ve

Drug Resistance and Antibiotics in use

Acinetobacter is often resistant to many commonly prescribed antibiotics.Multiple Drug Resistance (MDR) patterns observed in Acinetobacter baumannii  (MDR-AB) currently poses significant challenges for the management and treatment of infections. CDC has categorized Multidrug-resistant Acinetobacter as a serious threats to public health. 

Source

There are few antimicrobial agents that are commonly used for the treatment of infections with Acinetobacter baumannii .

These antibiotics are:

  1. Amikacin: Among Aminoglycosides, amikacin and tobramycin still shows activity against many A. baumannii isolates. Resistance with these drugs are increasing and drug susceptibility is needed to find out susceptibility pattern of a particular isolate.
  2. Carbapenems: Carbapenems (imipenem, meropenem, or doripenem) is one of the most important therapeutic options available to treat infections with multidrug-resistant A.baumannii. Antibiotics resistance (resistance ranging from 10% to as high as 70%) with carbapenems is increasing and the strains which are resistant to carbapenems are also resistant to majority of other antibiotics (except polymyxins or tigecycline).
  3. Colistin: An antibiotic of the Polymyxins group, colistin (polymyxin E) still shows excellent activity against Acinetobacter baumannii. Polymyxin B is also used in clinical practice. Colistin is effective for various Gram-negative rod-shaped bacteria, including multidrug-resistant Pseudomonas aeruginosa and Klebsiella pneumoniae.
  4. Tigecycline: A member of the glycylcylines antibiotics, tigecycline is a semisynthetic derivative of minocycline and inhibits the 30S ribosomal subunit. It has broader specturm of activity. Tigecycline is being used to treat MDR-A.baumannii infections but clinical data is not sufficient to ascertain its accuracy.
  5. Sulbactam: Sulbactam possesses greatest intrinsic bactericidal activity against A.baumannii isolates. It is one of the commonly used β-lactamase inhibitors and commercially available in combination with ampicillin.

References and further Readings:

  1. Treatment of Acinetobacter Infections
  2. Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside

 
About tankeshwar 363 Articles
Hello, thank you for visiting my blog. I am Tankeshwar Acharya. Blogging is my passion, I am working as a Asst. Professor and Microbiologist at Department of Microbiology and Immunology, Patan Academy of Health Sciences, Nepal. If you want me to write about any posts that you found confusing/difficult, please mention in the comments below.

3 Comments

  1. Thank you for the update on Acinetobacter.
    Please, what is the exact definition of “coccobacilli” and what exactly do coccobacilli look like?
    Thank you for your time.

     
  2. Thanks for this information. I found your blog and started following a couple of years back when I was studying for the ASCP micro specialist exam. an interesting thing about Acinetobacter— In the lab I can think of at least two times that techs have called an Acinetobacter gram positive coccobacilli on initial staining (I think it was blood culture both times) -i have read that this is characteristic of Acineotbacter from this site.

     
    • Thank you Anet for your comment. Happy to know that you are following my blog, i will really appreciate if you manage time and let me know how can i improve my posts so that it can be helpful for undergraduate students to understand fundamentals of Microbiology. Gram staining though is very simple procedure, still needs careful attention on timing and other factors, and may be something went wrong.
      May be they forget to decolorize or reported elsewhere because they are like other undergraduate students who remember “Chocolate is for Haemophilus, Blood Agar for GPC and MacConkey agar for GNR” but fail to realize GNR can grow both in BA and CA, and GPC in CA (may happen among those students who pay little attention in practicals but search internet or books for interesting mnemonics/phrases to remember the stuff).

       

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