THE INCIDENCE AND ANTIBIOTIC SENSITIVITY OF [601532]

THE INCIDENCE AND ANTIBIOTIC SENSITIVITY OF
ACINETOBACTER SPECIES
DANA CARMEN ZAHA 1, CSILLA SZABO 2, LUCIA GEORGETA DAINA 1
1FACULTATEA DE MEDICINĂ ȘI FARMACIE, UNIVERSITATEA DIN ORADEA
2LABORATORUL CLINIC AL SPITALULUI CLINIC JUDEȚEAN DE U RGENȚĂ ORADEA P
44
It is a retrospective study performed by using medical recor ds, and microbiology
database from the Clinical Laboratory of Clinical Emergenc y County Hospital
Oradea. The study was carried out during January-December 2 015. Clinical
specimens were tracheal or bronchial aspirates, pus, sputu m, blood, urine,
cerebrospinal fluid, peritoneal fluid. Identification wa s performed using the
standard microbiological methods. Testing for antibiotic sensitivity was done by
Kirby-Bauer diffusion method.RESULTS
FIGURE 1 FIGURE 2
FIGURE 3 From the total 9861 processed specimens, 249 Acinetobacter spp strains (0.025%)
were isolated of which 201 (80.7%) were from ICU and 48 (19.2% ) isolates were
from surgical and internal departments, the difference bei ng significantly statistics
(p = 0.04).
Most common Acinetobacter spp was isolated from tracheal as pirates (54.2%),
followed by wound infection (20.4%) and bronchial aspirate s (14%). Infections were
more common in males (57.4%) and were associated with major r isk factors (post-
surgical, diabetes mellitus, catheterization, extended h ospital stay, prolonged
antibiotic usage).
Acinetobacter baumannii was the most common species isolat ed (85%). The
maximum sensitivity of Acinetobacter spp.was seen to colis tin (98.9%), tigecycline
(66.3%), cefoperazone-sulbactam (43.1%) and sensitivity was intermediary for
fluoroquinolones. The strains showed no sensitivity to cep halosporins, piperacillin
tazobactam, carbapenems and macrolides.Introduction :Acinetobacter spp. is known as significant hospital pathog en with
antibiotic resistance to most of the commonly prescribed an timicrobials. This
study aims to isolate Acinetobacter spp from various clinic al specimens and to
determine its antimicrobial sensitivity pattern in our hos pital.
Methods : The study was carried out during January-December 2015. Cli nical
specimens were tracheal or bronchial aspirates, pus, sputu m, blood, urine,
cerebrospinal fluid, peritoneal fluid. Identification wa s performed using the
standard microbiological methods. Testing for antibiotic sensitivity was done by
Kirby-Bauer diffusion method.
Results : From the total 9861 processed specimens, 249 Acinetobacte r spp strains
(0.025%) were isolated of which 201 (80.7%) were from ICU and 48 (19.2%)
isolates were from surgical and internal departments, the d ifference being
significantly statistics (p = 0.04). Most common Acinetoba cter spp was isolated
from tracheal aspirates (54.2%), followed by wound infecti on (20.4%) and
bronchial aspirates (14%). Infections were more common in m ales (57.4%) and
were associated with major risk factors (post-surgical, di abetes mellitus,
catheterization, extended hospital stay, prolonged antib iotic usage). Acinetobacter
baumannii was the most common species isolated (85%). The ma ximum
sensitivity of Acinetobacter spp.was seen to colistin (98. 9%), tigecycline (66.3%),
cefoperazone-sulbactam (43.1%) and sensitivity was inter mediary for
fluoroquinolones. The strains showed no sensitivity to, pi peracillin tazobactam,
carbapenems and macrolides.
Conclusion : Acinetobacter infections, especially in ICU raise s special problems in
view of increasing antimicrobial resistance. Early identification and continued
surveillance will help prevent the spread of it in hospital environment.
Key words : Acinetobacter, antimicrobial resistance.
INTRODUCTION
Acinetobacter species are aerobic, non-motile, Gram (-) org anisms and over 25
different species had been described. Acinetobacter is mos t commonly found in
soil and water, but has also been isolated from animals. Acin etobacter baumannii
normally inhabits human skin, mucous membranes, and soil.1,2,3
Although many patients may be colonized, an increase in seri ous infections such
as bacteremia, pneumonia, urinary tract, and wound infecti ons are associated with
major risk factors (post-surgical, diabetes mellitus, cat heterization, extended
hospital stay, prolonged antibiotic usage).4,5Although carbapenems have been
recognized as the first-line therapy for AB infections, sig nificant increases in the
incidence of resistance to carbapenems and other antibioti cs has been increasing
reported.2
Patients with Acinetobacter colonization often have a hist ory of prolonged
hospitalization or antimicrobial therapy (with antibioti cs that have little or no
activity against Acinetobacter). It is particularly seen i n patients who are intubated
and in those who have multiple intravenous lines, monitorin g devices, surgical
drains, or indwelling urinary catheters. It is often cultur ed from hospitalized
patient’s sputum or respiratory secretions, wounds, and ur ine, and commonly
colonizes in irrigating solutions and intravenous fluids. Acinetobacter infections
usually involve organ systems with a high fluid content (e.g ., respiratory tract,
blood, CSF, peritoneal fluid, urinary tract). Invasive dev ices used to facilitate fluid
monitoring, administer medications, and provide lifesavi ng support may also be
sources of colonization. Risk factors for colonization or i nfection with multidrug-
resistant Acinetobacter species: prolonged length of hosp ital stay, exposure to an
intensive care unit (ICU), receipt of mechanical ventilati on, colonization pressure,
exposure to antimicrobial agents, recent surgery, invasiv e procedures
Due to long-term evolutionary exposure to soil organisms tha t produce antibiotics,
Acinetobacter sp. can develop antibiotic resistance extre mely rapidly, in contrast to
other clinical bacteria, which require greater time to acqu ire resistance, usually in
response to therapeutic strategies. Increasing resistanc e started appearing in
almost all groups of drugs including the first and second gen eration
cephalosporins.
This study aims to isolate Acinetobacter spp from various cl inical specimens and to
determine its antimicrobial sensitivity pattern in our hos pital .
METHODS
Clinical information collected includes: patient demogra phics (age, sex),
compartment, clinical, labco-morbidities (respiratory, gastrointestinal, malignancy,
genitourinary, diabetes, cardiovascular and other), and s ite of the culture,
susceptibility data, infection or colonization. Infectio n defined as positive culture
from sterile site, and respiratory secretion, urine and wou nds with and
radiological data that agree with infection.
Statistical analysis was performed using Pearson Chisquar e statistical testing.
DISCUSSION
Although numbers of AB positive cultures are not very high, e mergence of
antimicrobial resistance leaves physicians with a difficu lt choice in appropriate
therapy. This is further complicated by other factors such a s drug allergies.
Comorbidities among the patient population that were assoc iated with multi drug
resistance were respiratory and cardiovascular condition and surgical.
Patients with conditions such as chronic obstructive pulmo nary disease, chronic
VDRF, hypertension, or coronary arterial disease may be more likely to have a more
resistant pathogen. This could be important in earlier iden tification of patients on
ventilators that should be monitored more closely for infec tion control measures.CONCLUSIONS
Acinetobacter spp. are rapidly spreading with emergence of extended resistance to
even newer antimicrobials. They have the ability to acquire resistance at a much
faster pace than other gram-negative organisms. Due to their ease of survival in
the hospital environment, they have immense potential to ca use nosocomial
outbreaks. In addition to antibiotic resistance, their bio film forming ability plays a
crucial role in their in-vitro and in-vivo survival. Thus, t o decrease the spread of
Acinetobacter infections and reduce the pace of emergence o f resistance in
Acinetobacter, it is important to promote the rational use o f antimicrobials, with
implementation and monitoring of the Antibiotics Program i n hospitals.
Acinetobacter infections and colonization in hospital dep artments carry a high rate
of resistance. The increasing trend of colistimethate MIC v alues should also alert
physicians to restrict their use of this medication when pos sible.
ABBREVIATIONS
REFERENCES
1. Perez F, Hujer AM, Hujer KM, et al. Global challeng e of multidrug-resistant
Acinetobacter baumannii. Antimicrob Agents Chemother 2007;51(10):3471-84.
2. American Thoracic Society. Guidelines for the man agement of adults with
hospital-acquired, ventilatorassociated, and health care-associated pneumonia.
Am J Resp Crit Care Med 2005;171(4):388-416.
3. Chang HL, Tang CH, Hsu YM, Wan L, ChangYF, et al Nosocomial outbreak of
infection with multidrugresistant Acinetobacter baum annii in a medical center in
Taiwan. Infect Control Hosp Epidemiol.
2009;30:34-8.
4. Bergogne-Berezin E, Towner KJ. Acinetobacter spp. As nosocomial
pathogensMicrbiol Rev. 1996;9(2):148-165.
: microbiological, clinical, and epidemiologic feat ures. Clin 5. Fournier PE, Richet
H. The epidemiology and control of Acinetobacter ba umannii in health care
facilities. Clin Infect Dis 2006;42(5):692-9. CT = Colistin
TGC = Tigecycline
AK = Amikacin
MEM = Meropenem
ETP = Ertapemen
IMP = Imipenem
CN = Gentamicine
MXF = Moxifloxacine LEV = Levofloxacine
OFX = Ofloxacine
CIP = Ciprofloxacine
CXM = Cefuroxime
CAZ = Ceftazidime
CRO = Ceftriaxone
CEP = Cefoperazone
AMC = Amoxicilline/clavulanic acid
TPZ = Piperacillin/tazobactam
CES = Cefoperazone / sulbactam

FIGURE 4
REZUMAT
Introducere :Acinetobacter este cunoscut ca agent semnificativ patogen în spital
prezentând rezisten ță crescută la antimicrobienele prescrise. Acest studiu are
drept scop de a izola Acinetobacter spp. din diverse probe clinice și de a
determina spectrul de sensibilitate antimicrobiană în spi talul nostru.
Metode : Studiul a fost realizat în perioada ianuarie-decembrie 20 15. Probele au
fost secre ții traheale sau aspirate bron șice, sputa, sânge, puroi, urină, lichid
cefalorahidian, lichid peritoneal. Identificarea specii lor a fost efectuată utilizând
tehnicile standard de microbiologie. Testarea sensibilit ă ții antimicrobiene s-a
realizat prin metoda difuzimetrică.
Rezultate : Dintr-un număr total de 9861 probe prelucrate au fost izola te 249
tulpini Acinetobacter spp. (0.025%) dintre care 201 (80.7%) au fost de la ATI și 48
(19.2%) de la sec țiile chirurgicale și interne, diferen ța semnificativ statistic (p =
0.04).Acinetobacter spp a fost izolat mai frecvent în secre țiile traheale(54.2%),
urmate de infec ții ale plăgilor(20.4%) și aspiratele bron șice(14%). Infec țiile au fost
mai frecvente la bărba ți (57 .4%) fiind asociate cu factori majori de risc (post-
chirurgical, diabet zaharat, cateterizare, spitalizare p relungită, administrare
prelungită de antibiotice). Acinetobacterbaumannii a fost cel mai frecvent izolat
(85%). Sensibilitatea maximă a fost observată la colimicin a (98.9%), tigeciclina
(66.3%), cefoperazona-sulbactam (43.1%) și intermediară pentru fluorochinolone.
Tulpinile nu au prezentat sensibilitate la cefalosporine, piperacilina-tazobactam,
macrolide și carbapeneme.
Concluzii : Infec țiile cu Acinetobacter spp. ridică probleme deosebite având în
vedere rezisten ța antimicrobiană în cre ștere. Identificarea precoce și
supravegherea continuă vor ajuta la prevenirea răspândiri i în mediul spitalicesc.
Cuvinte cheie : Acinetobacter, rezisten ța antimicrobiană
.
ABSTRACT
Colonial growth displayed by Acinetobacter spp cult ured
on a blood agar plate
FIGURE 5
FIGURE 5 Acinetobacter baumannii (from the left to right):
TSI: G-, L-, Z-, H2S-
MIU: I-, M-, uree-
Simmons: +