% vol = 14 number = 4 prevlink = 178 nextlink = 183 titolo = "MULTIRESISTANT ACINETOBACTER INFECTION IN A BURNS UNIT" volromano = "XIV" data_pubblicazione = "December 2001" header titolo %>
SUMMARY. Acinetobacter is a gram-negative bacteria of the Neisseriaceae family. A very rare strain of multiresistant Acinetobacter baumanii was identified in the Burns Unit of Coimbra University Hospitals (Portugal) in January and February 1999. This infectious episode involved 11 patients and made it necessary to take strong hygiene and isolation measures.
Acinetobacter is a saprophyte bacteria found in live organisms and inanimate beings.1 About 25% of people are healthy carriers. Owing to its scarce virulence, the great majority of infections are produced in the hospital environment,2 with a greater incidence in patients who are seriously ill and even in a critical state, with central venous lines, vesicle probes, mechanical ventilation, etc.3 Acinetobacter can also be found in the soil, water, pasteurized milk, frozen food, hospital air-conditioning systems, water deposits, dialysis fluids, hospital mattresses, humidifiers, and oxygen systems.
The close relationship between Acinetobacter bacteriaemia and/or sepsis and surgical procedures or permanent venous lines suggests that the skin is one of the main entrances for this micro-organism.3 The great incidence of Acinetobacter pneumonia as a primary infection or superinfection indicates that the airways can be a further path for bacterial contamination.4 Acinetobacter can also be found in urethral, vaginal, and conjunctival secretions, expectoration, blood, pleural fluid, cerebrospinal fluid, synovial fluid, ascitic fluid, stools, skin ulcers, abscesses, etc.
Relevant factors in the pathogenesis of Acinetobacter infections include the patients age; previous treatment with wide spectrum antibiotics, steroids, cytostatics, and immunosuppressors; parenteral nutrition; and admission to ICUs, burn units, etc.
The most important infections caused by Acinetobacter are meningitis, acute and subacute bacterial endocarditis, pneumonia, genitourinary infections, sepsis, peritonitis, corneal ulcers, hepatic and pancreatic abscesses, oral abscesses, and soft tissue infections.
For the diagnosis of Acinetobacter infections it has to be isolated from blood, cerebrospinal fluid, expectoration, urine, or pus. Tests of bacterial sensibility to antibiotics should always be performed.
The Burns Unit of Coimbra University Hospitals has 10 rooms and receives burn patients from all over Portugal. Each patient is isolated and adequately monitored.
In the months of January and February 1999, the Burns Unit admitted 11 patients in whom infections by multiresistant Acinetobacter were found. As normal, all the patients antibiotherapy was guided by tests of bacterial sensibility to antibiotics. These tests demonstrated the presence of resistance to penicillin, ampicillin, cephalosporins, imipenem, piperacilin-tazobactan, polymixine, ciprofloxacin, amycacin and gentamicin. Some intermediate sensibility to tobramycin was found in five patients.
Apart from the therapies instituted in each patient in whom infection was found, the following strict hygiene measures were taken without delay for the prevention of dissemination:
Out of a total of 11 patients admitted to the burns unit where Acinetobacter infection had developed:
Of the 5 male patients:
Of the 6 female patients:
The total burned body surface area ranged from 8.5% to 70%.
The patients age range was from 22 to 90 years.
Multiresistant Acinetobacter infections are not unknown in burns units. The problem of nosocomial infections is summed up in the concept of a vulnerable host placed in a hostile environment.2
The interaction between host and micro-organism defines the clinical outcome and is influenced by many factors (metabolic, nutritional, therapeutic, etc.).
When nosocomial infections arise, they complicate patient evolution, lengthen convalescence, and increase economic costs, morbidity, and mortality.
RESUME LAcinetobacter est une bactérie à Gram négatif de la famille Neisseriaceae. Les Auteurs ont identifié une souche très rare dAcinetobacter baumanii dans lUnité des Brûlures des Hôpitaux Universitaires de Coimbra (Portugal) en janvier et février 1999. Cet épisode dinfection a intéressé 11 patients et il a été nécessaire de prendre des mesures sévères dhygiène et disolement.