Journal of Postgraduate Medicine
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Year : 1989  |  Volume : 35  |  Issue : 1  |  Page : 14-6  

Nosocomial infections due to Acinetobacter calcoaceticus.

FF Zaer, LL Deodhar 
 

Correspondence Address:
F F Zaer


Abstract

Fifty four isolates of Acinetobacter calcoaceticus were studied in a period of 6 months. Maximum isolates were from burns cases and environmental sampling from burns ward also grew the same organism, indicating their role as nosocomial pathogen. Acinetobacter may initially be mistaken for Neisseria species. As the organisms show multidrug resistance to commonly used antibiotics their correct identification is important.



How to cite this article:
Zaer F F, Deodhar L L. Nosocomial infections due to Acinetobacter calcoaceticus. J Postgrad Med 1989;35:14-6


How to cite this URL:
Zaer F F, Deodhar L L. Nosocomial infections due to Acinetobacter calcoaceticus. J Postgrad Med [serial online] 1989 [cited 2019 Aug 19 ];35:14-6
Available from: http://www.jpgmonline.com/text.asp?1989/35/1/14/5732


Full Text



 INTRODUCTION



The nomenclature of the genus Acinetobacter has been marked with continuous changes, and 12 to 17 synonyms have been proposed and used by various authors.[2] The most common are Herellea vaginicola, Bacterium antitratum and Mima polymorpha. Because of the taxonomic problems, the early literature on the clinical significance of the organism is confusing.

Nosocomial infections due to Acinetobacter calcoaceticus have increased in recent years.[3],[6] Pyrogenic reactions in dialysis unit due to heparinized saline being contaminated[3] and outbreak in burns wards due to contaminated mattresses and beddings have also been reported. To the best of our knowledge very little data on Acinetobacter is available in Indian Medical literature and therefore this study is reported.

 MATERIAL AND METHODS



Samples (pus swabs, urine, peritoneal fluid, blood cultures etc.) received in the laboratory were processed and standard procedures[4] were used for identification of the organisms.

The antimicrobial susceptibility tests were done by disc diffusion method. The separation of the acinetobacter species into two varieties i.e. anitratus and lwoffi was based on hemolytic activity and ability to oxidatively utilise glucose and xylose.[2]

In the cases, where acinetobacter was isolated, detailed history of the patients was recorded especially with reference to surgery, instrumentation or other therapeutic procedures. Bacteriological studies of environmental samples were done wherever nosocomial infections were suspected, and the samples were obtained from mattresses, lockers, cot, floor, linen etc.

 RESULTS



In a period of 6 months (March to August 1988) there were 54 isolates of acinetobacter. Maximum isolates were from burns cases and seven isolates from septicemia cases were identified in pure culture.

Majority of strains showed resistance to penicillin, ampicillin, tetracycline, erythromycine and furadantin while the strains were sensitive to gentamicin, kanamycin, amikacin, norfloxacine.

Acinetobacter calcoaceticus was isolated from a total of 21 environmental samples from the burns wards where patients were admitted and the patients swabs (20) revealed isolation of Acinetobacter calcoaceticus. These environmental isolates had similar antibiograms as the clinical isolates.

In one case, where eviscerated eye contents revealed Acinetobacter, the sample of saline used for irrigating the eye prior to the operation, also grew Acinetobacter calcoaceticus.

In two other cases, one where peritoneal dialysis was done, the returning fluid on culturing grew Acinetobacter and in another case, a ventricular shunt was inserted following which the child developed meningitis, and C.S.F. grew Acinetobacter.

 DISCUSSION



The organism Acinetobacter calcoaceticus in the community is rarely pathogenic but in the hospital population it is a common nosocomial pathogen. It is usually found in the hospital in the areas where there is an accumulation of moisture but the organisms can stand drying better than enterobactericeae and this also explains their occurrance on the skin of the hospitalised patients.

A report from the National nosocomial infection study[7] from U.S.A. between 1974 and 1977 showed that Acinetobacter was associated with 0.76% of the 1,80,982 nosocomial infections. A study conducted by Paramsivan et al[5], at JIPMER, Pondicherry on nonfermenting Gram negative bacteria (NFGNB) in human infections revealed a total of 108 samples of NFGNB out of which 28% isolates were Acinetobacter calcoaceticus. However, as per the reference,[5] no environmental studies were undertaken by these authors. Pickett et al[6] showed Acinetobacter calcoaceticus to be the second most common clinical isolate (7%) after Pseudomonas aeruginosa (66%). Recently, a report from Tata Memorial Hospital[9] described 3 deaths in leukemic children who received injection with contaminated anti-leukemic drugs, and the culprit turned out to be Acinetobacter.

In the present study, 20 out of 54 isolates were from burns patients; the environmental sampling of this ward also grew the same organism and their antibiograms were identical. In case of panophthalmitis patient, the source of infection was contaminated saline.

As the organisms can be mistaken for Neisseria species, they are multidrug resistant to commonly used antibiotics, their identification in the laboratory as a nosocomial pathogen is important.

References

1Cruickshank, R., Duguid, J. P., Marmion, B. P. and Suain, R. H. A.: Tests for sensitivity to antimicrobial agents. In, "Medical Microbiology". 12th Ed., Vol. 2, Churchill Livingstone. Edinburg, London and New York, 1975, pp. 190-208.
2Davis, E. C. and Baer, H.: "Gram negative cocci "Acinetobacter". In, Infectious Disease and Medical Microbiology. Editors: I. A. Braude, E. C. Davis, J. Fierer, 2nd Ed., W. B. Saunder's Company, Philadelphia/'London/Toronto, 1986, pp. 287-291.
3Kantor, R. J., Carson, L. A., Graham, D. R., Peterson, J. N. and Farero, M. S.: Outbreak of pyrogenic reactions at a dialysis center. Amer. J. Med., 74: 449-463, 1983.
4Koneman, W. E., Allen, D. S., Dowell, V. R. Jr. and Sommers, M. H.: The nonfermentative Gram negative bacilli. In, Colour Atlas and Text Book of Diagnostic Microbiology, 2nd Ed., J. B. Lippincott Company, Philadelphia/St. Louis/London. 1983, pp. 125-184.
5Paramasivan, C. N., Rao, R. S., Sivadasan, K., Anupurba, S., Kanungo, R. and Prabhekar, R. Non-fermenting Gram negative bacteria in human infections. Ind. J. Med. Microbiol., 6: 73-79, 1988.
6Pickett, M. J. and Pedersen, M. M.: Nonfermentative bacilli associated with man II. Detection and Identification. Amer. J. Clin. Pathol., 54: 164-177, 1970.
7Sheretz, R. J. and Sullivan, M. L.: An out, break of infection with Acinetobacter cal coaticus in burn patients, contamination of patients mattresses. J. Inf. Dis, 151: 252-258, 1985.
8Smith, P. W. and Massanari, R. M.: Room humidifiers as a source of Acinetobacter infections. J. Amer. Med. Assoc., 237: 795-797, 1977.
9Staff Reporter, Times of India, Bombay. Monday May 9, 1988.

 
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