Download - Acinetobacter baumannii review project

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


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


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)


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


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.