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Acinetobacter baumannii review project
Acinetobacter baumannii review project
Dr. Joseph TimponeDr. Sonia Qasba
Dr. Matthew Sincock
Dr. Joseph TimponeDr. Sonia Qasba
Dr. Matthew Sincock
Acinetobacer baumanniiAcinetobacer baumanniiA. baumannii is a gram negative bacteria
that is often a source of nosocomial infections
Unfortunately it has the potential to often be multi-drug resistant
Recently it has gotten more attention because of numerous cases being reported in soldiers from Iraq and Afghanistan
Interestingly, during the Vietnam war this was the most common gram negative bacillus to contaminate wounds
A. baumannii is a gram negative bacteria that is often a source of nosocomial infections
Unfortunately it has the potential to often be multi-drug resistant
Recently it has gotten more attention because of numerous cases being reported in soldiers from Iraq and Afghanistan
Interestingly, during the Vietnam war this was the most common gram negative bacillus to contaminate wounds
A. baumanniiA. baumannii
A. baumannii can be similar to pseudomonas in the sense that typically “healthy people don’t get it”
It is uncommon across the U.S. in general medical floors, but can reach a very high percentage of infections in ICU settings (and may be on the rise)
A. baumannii can be similar to pseudomonas in the sense that typically “healthy people don’t get it”
It is uncommon across the U.S. in general medical floors, but can reach a very high percentage of infections in ICU settings (and may be on the rise)
A. BaumanniiA. Baumannii
Resistance to multiple drugs can be through both overexpression of efflux pumps or expression of ß-lactamases (including ESBLs and metallo-ß-lactamases which can cause carbapenem resistance)
This can necessitate use of drugs with greater toxicity (such as polymyxins)
Resistance to multiple drugs can be through both overexpression of efflux pumps or expression of ß-lactamases (including ESBLs and metallo-ß-lactamases which can cause carbapenem resistance)
This can necessitate use of drugs with greater toxicity (such as polymyxins)
A. baumanniA. baumanni
Resistance genes can often be found on the same portion of the bacterial genome and therefore co-expression can be problematic
This means that it is possible that use of “just a touch of cipro” can place a patient at increased risk for MRSA and/or MDR organisms (like a. baumannii)
A. baumannii has been placed on the IDSA “hit list” as a dangerous microbe
Resistance genes can often be found on the same portion of the bacterial genome and therefore co-expression can be problematic
This means that it is possible that use of “just a touch of cipro” can place a patient at increased risk for MRSA and/or MDR organisms (like a. baumannii)
A. baumannii has been placed on the IDSA “hit list” as a dangerous microbe
A. baumanniiA. baumannii
Unfortunately, even cases of colistin resistance appear in the literature, and a. baumannii was singled out as more problematic than pseudomonas
Tigecyline has been shown to have activity against a. baumannii (but not pseudomonas) but not many other options
Unfortunately, even cases of colistin resistance appear in the literature, and a. baumannii was singled out as more problematic than pseudomonas
Tigecyline has been shown to have activity against a. baumannii (but not pseudomonas) but not many other options
BackgroundBackground
This project is focused on looking at infections with a. baumannii that occurred at GUH
It was noted by the ID staff that there were numerous patients infected with a. baumannii and it was thought that this deserved a closer look
This project is focused on looking at infections with a. baumannii that occurred at GUH
It was noted by the ID staff that there were numerous patients infected with a. baumannii and it was thought that this deserved a closer look
BackgroundBackground
What made these infections stand out was that:They were often multi-drug resistantThey were occurring frequently in the ICU
settingThey were often very difficult to treat
The study is similar to a study involving multi-drug resistant pseudomonas infections
What made these infections stand out was that:They were often multi-drug resistantThey were occurring frequently in the ICU
settingThey were often very difficult to treat
The study is similar to a study involving multi-drug resistant pseudomonas infections
BackgroundBackground
Currently this project is in the final portion of the data collection phase
Statistical analysis will begin once the collection phase is complete
As results are not available, this talk will focus more on study design/questions that we are hoping to answer
Currently this project is in the final portion of the data collection phase
Statistical analysis will begin once the collection phase is complete
As results are not available, this talk will focus more on study design/questions that we are hoping to answer
Data collectionData collection
First the patient population had to be identified
Using Azzyxi and the micro lab records we were able to identify all patients who had cultures positive for a. baumannii over a period of three years (2004-2006)
First the patient population had to be identified
Using Azzyxi and the micro lab records we were able to identify all patients who had cultures positive for a. baumannii over a period of three years (2004-2006)
Data collectionData collection
From this group of patients those appropriate to the study were defined as:Age 18 or olderThey must have been admitted to the
hospitalThe culture must represent an
infection and not only colonization
From this group of patients those appropriate to the study were defined as:Age 18 or olderThey must have been admitted to the
hospitalThe culture must represent an
infection and not only colonization
Data collectionData collection
Basic demographic data was collected including:AgeRaceGender
Basic demographic data was collected including:AgeRaceGender
Questions…Questions…
The next portion will focus more on which questions were asked and how that affected the focus of our data collection
Each question that is trying to be answered by the review has pertinent questions in our data abstraction form
The next portion will focus more on which questions were asked and how that affected the focus of our data collection
Each question that is trying to be answered by the review has pertinent questions in our data abstraction form
GoalsGoals
Are there common threads in terms of the reason for admission or the past medical historyReason for admissionDuration of admissionPast medical historyInitial hospital unit on admissionWas the patient ever in an intensive care
unit setting
Are there common threads in terms of the reason for admission or the past medical historyReason for admissionDuration of admissionPast medical historyInitial hospital unit on admissionWas the patient ever in an intensive care
unit setting
GoalsGoals
Are the patients in question acquiring the infection at GUH or at an outside facility?Was the patient recently hospitalizedWas the patient transferred from
another hospitalWas the patient coming from a
nursing home
Are the patients in question acquiring the infection at GUH or at an outside facility?Was the patient recently hospitalizedWas the patient transferred from
another hospitalWas the patient coming from a
nursing home
GoalsGoals
What are the risk factors these patients share for this particular infectionPresence of central line, foley, a-line,
nasogastric tube, or any other foreign linesHistory of chronic medical conditions such
as DM, CHF, ESRD, ESLD, alcohol abuse, etc.Recent immunosuppresive therapy with
either steroids, chemotherapy, or other cytotoxic/immunomodulator agents
What are the risk factors these patients share for this particular infectionPresence of central line, foley, a-line,
nasogastric tube, or any other foreign linesHistory of chronic medical conditions such
as DM, CHF, ESRD, ESLD, alcohol abuse, etc.Recent immunosuppresive therapy with
either steroids, chemotherapy, or other cytotoxic/immunomodulator agents
GoalsGoals
Risk factors continuedConditions such as HIV or
hematologic malignancy that can affect immune function
Recent surgery/traumaRecent episode of SIRS/shock that
could have stressed the immune system
Risk factors continuedConditions such as HIV or
hematologic malignancy that can affect immune function
Recent surgery/traumaRecent episode of SIRS/shock that
could have stressed the immune system
GoalsGoals
Did the antibiotic resistance profile of the a. baumannii remain the same over time or change
This is an important question because it speaks to the effect of antibiotics and how they can inadvertently cause more serious infections further into the hospitalization
Did the antibiotic resistance profile of the a. baumannii remain the same over time or change
This is an important question because it speaks to the effect of antibiotics and how they can inadvertently cause more serious infections further into the hospitalization
GoalsGoals
Resistance profileDid the profile change over timeDoes a relation exist between prior
exposure to antibiotics and development of resistance
Does a relation exist between development of resistance and attempts at treating the infection
Resistance profileDid the profile change over timeDoes a relation exist between prior
exposure to antibiotics and development of resistance
Does a relation exist between development of resistance and attempts at treating the infection
GoalsGoals
Data was collected on all antibiotic exposure both prior to the first culture positive for a. baumanni and after that culture
Changes in resistance patterns over time were also recorded
Data was collected on all antibiotic exposure both prior to the first culture positive for a. baumanni and after that culture
Changes in resistance patterns over time were also recorded
GoalsGoals
OutcomesWas the infection from a. baumannii
successfully treated clinicallyWas there documented clearance of
the infection by repeat cultureDid the patient survive to dischargeDid the patient discharge to home or
to another facility
OutcomesWas the infection from a. baumannii
successfully treated clinicallyWas there documented clearance of
the infection by repeat cultureDid the patient survive to dischargeDid the patient discharge to home or
to another facility
ResultsResults
Well…how about you ask me about those in a few months?
Questions?
Well…how about you ask me about those in a few months?
Questions?
ReferencesReferences Mandell, Bennett & Dolin: Principles and Practices of Infectious Diseases, 6th
edition. Churchhill/Livingston. Chapter 219. Importation of multidrug-resistant Acinetobacter spp infections with
casulaties from Iraq. Jones A. et. al. The Lancet Infectious Diseases 01-Jun-2006; 6 (6): 317-8
Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. McGowan JE et. al. American Journal of Medicine. 01-Jun-2006; 119 (6 Suppl 1): S29-36
First-generation fluoroquinolone use and subsequent emergence of multiple drug-resistant bacteria in the intensive care unit. Nseir S. et. al. Critical Care Medicine. 01-Feb-2005; 33(2): 283-9.
ISDA releases “hit list”. Nelson R. Lancet Infectious Diseases. May 2006; 6(5): 265
Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. Li J. et. Al. Lancet Infectious Diseases. 01-Sept-2006; 6(9): 589-601.
Mechanisms of resistance of bacteria causing ventilator associated pneumonia. Szabo D. et al. Clinical Chest Medicine. 01-Mar-2005; 26(1): 75-9.
Mandell, Bennett & Dolin: Principles and Practices of Infectious Diseases, 6th edition. Churchhill/Livingston. Chapter 219.
Importation of multidrug-resistant Acinetobacter spp infections with casulaties from Iraq. Jones A. et. al. The Lancet Infectious Diseases 01-Jun-2006; 6 (6): 317-8
Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. McGowan JE et. al. American Journal of Medicine. 01-Jun-2006; 119 (6 Suppl 1): S29-36
First-generation fluoroquinolone use and subsequent emergence of multiple drug-resistant bacteria in the intensive care unit. Nseir S. et. al. Critical Care Medicine. 01-Feb-2005; 33(2): 283-9.
ISDA releases “hit list”. Nelson R. Lancet Infectious Diseases. May 2006; 6(5): 265
Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. Li J. et. Al. Lancet Infectious Diseases. 01-Sept-2006; 6(9): 589-601.
Mechanisms of resistance of bacteria causing ventilator associated pneumonia. Szabo D. et al. Clinical Chest Medicine. 01-Mar-2005; 26(1): 75-9.