Download PDF
CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2018; 08(03): 017-024
DOI: 10.1055/s-0040-1708758
Original Article

Urinary tract infections by multidrug resistant Acinetobacter species- A Retrospective Analysis

Prashant Mule
1   Consultant Microbiologist, Dept of Microbiology and Molecular Microbiology, Metropolis Healthcare Ltd, Mumbai, India - 400 070
,
Niranjan Patil
2   Consultant Microbiologist, Dept of Microbiology and Molecular Microbiology, Metropolis Healthcare Ltd, Mumbai, India - 400 070
,
Seema Gaikwad
3   Consultant Microbiologist, Dept of Microbiology and Molecular Microbiology, Metropolis Healthcare Ltd, Mumbai, India - 400 070
› Author Affiliations
› Further Information
Also available at
 PDF Download Permissions and Reprints

Abstract

Background: Acinetobacter species have emerged as important cause of nosocomial infections like pneumonia and urinary tract infections. Acinetobacter species are known to be highly resistant to commonly used antimicrobial agents. SinceAcinetobacter species are ubiquitous and have tremendous colonizing capacity, it is difficult to explain the role of Acinetobacter acquisition in the ICU and medical wards. The objective of this study was to determine the frequency of urinary tract infection (UTI) caused by different Acinetobacter species in hospitalized patients and in the community and to analyze their antimicrobial susceptibility pattern.

Materials and Methods: This is a retrospective analysisfrom January 2016 to December 2017. Urine samples collected in appropriate sterile manner were screened for polymorphonuclear leucocytes and bacteria by routine microscopic examination. This was followed by plating on MacConkey's agar and Blood agar. Isolated Acinetobacter strains which are oxidase negative and non-lactose fermenters from MacConkey's agar were identified with Matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) to confirm the TM identification. Antibiotic susceptibility was performed by VitekCompact™ 2 (Biomeuriux, France) as per CLSI standards establishing MIC (Minimum Inhibitory Concentration).

Results: Of the 429 isolates of Acinetobacterspecies from urinary tract, Acinetobacterbaumannii complex (78%) found to be the most common species followed by Acinetobacterjunii(10%) and Acinetobacterbaumannii(8%). Of the 334 (78%) isolates of Acinetobacterbaumannii complex from urinary tract, 73 (21.85%) isolates were resistant with doripenem, 62 (18.56%) with imipenem and 59 (17.66%) were resistant with meropenem with MIC values >=8 μg/ml. The rest of the isolates like Acinetobacterjunii, Acinetobacterjohnsonii, andAcinetobacterlwoffiiare found to be more sensitive with carbapenems with lower MIC values.

Discussion: The treatment of multidrug-resistant bacteria in hospitalized patients continues to be a challenge for the clinician's in routine practice. Acinetobacter baumannii complex has proven to be an important pathogen in health care associated infections with significant mortality and morbidity. The drug resistant nature of the pathogen and its unpredictable susceptibility patterns make empirical and therapeutic decisions even more difficult.

Conclusion: A. baumanniiis an important opportunistic agent of nosocomial UTI, especially in patients with longer hospitalization, antibiotic exposure, urinary catheterization and decreased immunity. High antimicrobial resistance and patient co-morbidities limit therapeutic choices. Hence, alternative therapeutic options are urgently needed to treat a patient with A. baumanniiinfection.

Keywords

Nosocomial infections - Acinetobacter baumannii complex - MALDI-TOF MS - Urinary catheterization


Publication History

Received: 08 January 2018

Accepted: 10 June 2018

Article published online:
21 April 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Prashanth K, Badrinath S. Nosocomial infections due to Acinetobacter species: Clinical findings, risk factors and prognostic factors. Indian J Med Microbiol 2006; 24:39-44.
  • 2 Deep A, Singhi S. Nosocomial infections in PICU. Pediar Today 2004; 783-92.
  • 3 Sinha M, Srinivasa H. Mechanisms of resistance to carbapenams in Meropenem resistant Acinetobacter isolates from clinical samples. Indian J Med Microbiol 2007; 25:121-125.
  • 4 Berogue-Berezin E, Towner KJ. Acinetobacter species as nosocomial pathogen:Microbiological, clinical and epidemiological. ClinMicrobiol Rev 1996; 9:365-366.
  • 5 Vinodkumar CS, Neelagund F. Acinetobacter septicemia in neonates. Indian J Med Microbiol 2004; 22:71.
  • 6 Manikal VM, Landman D, Saurma G, Oydna E, Lal H, Quale J. Endemic carbapenam-resistant Acinetobacter species in Brooklyn, New York: Citywide prevalence, inter-institutional spread and relation to antibiotic usage. Clin Infect Dis 2000; 31:101-106.
  • 7 Bou G, Cervero G, Dominguez MA, Quereda C, Martinez-Beltran J. Characterization of a nosocomial outbreak caused by a multiresistant Acinetobacter baumanii strain with a carbapene-hydrolysing enzyme: High level carbapenem resistance in A.baumanii is not due solely to the presence of beta-lactamase. J ClinMicrobiol 2000; 38:3299-3305.
  • 8 Forster DH, Daschner FD. Acinetobacter species as nosocomial pathogens. Eur J Clin Microbiological Infect Dis 1998; 17:73-77.
  • 9 Grimont F, Grimont PA. Ribosomal ribonucleic acid gene restriction patterns as potential taxonomic tools. Ann Inst Pasteur Microbiol. 1986 Sep-Oct; 137B (2):165–175.
  • 10 Tjernberg I, Ursing J. Clinical strains of Acinetobacter classified by DNA-DNA hybridization. APMIS. 1989 Jul; 97(7):595–605
  • 11 Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008; 46(8):1254–1263.
  • 12 Jang T, Lee S, Huang C, Lee C, Chen W. Risk factors and impact of nosocomial acinetobacterbaumanniiblood stream infections in the adult intensive care unit: a case-control study. J Hosp Infect 2009; 73: 143–150.
  • 13 Mahgoub S, Ahmed J, Glatt AE. Underlying characteristics of patients harboring highly resistant Acinetobacter baumannii. Am J Infect Control 2002; 30(7):386–390.
  • 14 Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. ClinMicrobiol Rev 2008; 21(3):538–582.
  • 15 Falagas ME, Rafailidis PI. Attributable mortality of Acinetobacter baumannii: no longer a controversial issue. Crit Care 2007; 11(3):134.
  • 16 Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumanniiinfections in critically ill patients: a systematic reviewof matched cohort and case-control studies. Crit Care 2006; 10(2):R48.
  • 17 Abbo, A., Navon-Venezia, S., Hammer-Muntz, O., Krichali, T., Siegman- Igra, Y., Carmeli, Y., 2005. Multidrug-resistant Acinetobacter baumannii. Emerg. Infect. Dis. 11, 22–29.
  • 18 Jung, J., Park, W., 2015. Acinetobacter species as model microorganisms in environmental microbiology: current state and perspectives. Appl. Microbiol. Biotechnol. 99, 2533–2548.
  • 19 Peleg, A.Y., Seifert, H., Paterson, D.L., 2008. Acinetobacter baumannii: emergence of a successful pathogen. Clin. Microbiol. Rev. 21, 538–582.
  • 20 Manchanda, V., Sanchaita, S., Singh, N., 2010. Multidrug resistant Acinetobacter. J. Global Infect. Dis. 2, 291.
  • 21 Jain, R., Danziger, L.H., 2004. Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians. Ann. Pharmacother. 38, 1449–1459.
  • 22 Perez, F., Hujer, A.M., Hujer, K.M., Decker, B.K., Rather, P.N., Bonomo, R.A., 2007. Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob. Agents Chemother. 51, 3471–3484.
  • 23 Potron, A., Poirel, L., Nordmann, P., 2015. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and Acinetobacter baumannii: mechanisms and epidemiology. Int. J. Antimicrob. Agents 45, 568– 585.
  • 24 Dinc, G., Demiraslan, H., Elmali, F., Ahmed, S.S., Alp, E., Doganay, M., 2015. Antimicrobial efficacy of doripenem and its combinations with sulbactam, amikacin, colistin, tigecycline in experimental sepsis of carbapenem-resistant Acinetobacter baumannii. N. Microbiol. 38, 67–73.
  • 25 Eliopoulos, G.M., Maragakis, L.L., Perl, T.M., 2008. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin. Infect. Dis. 46, 1254–1263.
  • 26 Yadav, R., Landersdorfer, C.B., Nation, R.L., Boyce, J.D., Bulitta, J. B.,
  • 27 Vourli, S., Frantzeskaki, F., Meletiadis, J., Stournara, L., Armaganidis, A., Zerva, L., Dimopoulos, G., 2015. Synergistic interactions between colistin and meropenem against extensively drug-resistant and pandrug-resistant Acinetobacter baumannii isolated from ICU patients. Int. J. Antimicrob. Agents.