Impact of Imipenem resistantance on mortality with patients with Acinetobacter

A relatively benign bug becomes a highly lethal pathogen, known to U.S. soldiers as Iraqibacter. Stay the Course In the spring of 2004 the military and CDC sent a team of infectious disease specialists to Iraq to determine the source of the Acinetobacter baumannii infections coming back with the wounded soldiers and civilians.   They found no Acinetobacter baumannii in the soil in Iraq.  It was determined that one specific strain of Acinetobacter baumannii that was infecting most the soldiers matched a strain that originated in and had been infecting hospitalized patients in Europe.  Despite this knowledge by their own discovery you will see repeated statements in interviews and articles from the military that claim the Acinetobacter baumannii  originated in the soil in Iraq. In November, Duane Hospenthal, an infectious-disease expert at Brooke Army Medical Center in Texas and a consultant to the Army Surgeon General, said, "The question really has been: Is it coming from these old facilities we're using in Iraq? Is it coming from some of the Iraqi patients we have? Is it normal flora for our deployed soldiers who have been there for a while? Or is it being blown into them from shrapnel, dirt, and other materials by these explosive devices?" Hospenthal added that he believes there is little cause for concern. "It's a low-grade, low-virulence pathogen that can be recovered from soil and water. Without having it blasted into you or your being immunocompromised, it's not going to hurt you. We still see Acinetobacter, but now that it's been recognized, people are less excited about it here. It's hard for me to even understand if this is a big issue." But While Duane is rolling over for his bosses, Col. Bruno Petrucelli, the U.S. Army’s senior epidemiologist, says "the organism’s resistance to most drugs as well as its high casualty rate makes it potentially very dangerous." Now we have CNN rolling over for the Pentagon May 9, 2007 Years after the military knew AB was not from the soil in Iraq ROBERTS:  I'm just thinking about these stories out yesterday about these EFPs and other improvised-explosive devices, where insurgents and terrorists and now coating them with animal excrement and other bits of awful to try to inflict, you know, greater casualties by, you know, creating these wounds that just will not heal and become resistant to antibiotics. CALDWELL: John, we continue to see them use any kind of tactic that can -- will, you know, inflict more casualties and cause more fear and intimidation amongst the people and the security forces, just like they do with these chlorine tanks that they put on top of their bombs, so they have a chlorine fume that is caused. I mean, it just shows you the type of nature the enemy we're fighting against over here and what we're up -- having to deal with. This interview shows the nature of the DoD/Pentagon and what we're up--having to deal with! After months of refusing to discuss Acinetobacter publicly it appears the Pentagon has opened up with a misinformation campaign designed to make it appear that this is a new mysterious problem that they are burdened with.   The most obvious of these lies is that the bombs are spreading mysterious infections.  Biologics cannot withstand the intense heat produced by bombs and IED's. The disbursement method for biologics is more complicated CNN Transcript May 8  The Situation Room    CNN Transcript May 9   American Morning

Illness in a Redeployed Soldier Although malaria and leishmaniasis continue to be the most common deployment-related illnesses, brucellosis must also be considered in the differential of any redeployed soldier with headache, fever, and body aches November 12, 2006 Dead men walking At the NNMC in Bethesda, surgeons are pushing the boundaries of surgery. The marines they are working on have wounds from Iraq that have never been seen. The injuries are infected and they are severe. The lessons learnt are unique to this theatre and this war. They cannot clean these wounds Even the soil and water in Iraq carry a virulent strain of bacteria. Acinetobacter is resistant to most common antibiotics and, if left untreated, can lead to pneumonia, fever and septicaemia. It has been identified in more than 240 military personnel in the US since 2003, killing five; and in British troops too

Presentation by LTCM Kyle Peterson

Genome of Meningitis Causing Bacteria Uncovered 05/03/2007 - Yale University researchers have sequenced the genome of a bacteria that can cause various infections, including meningitis and pneumonia.

Antibiotic resistance of Acinetobacter baumannii isolates: data from Ibni Sina Hospital for the year 2002 Time for a little science perspective on the rare blood infection experienced by U.S. Troops returning from the battlefront.

Rare Blood Infection Surfaces in Injured U.S. Soldiers Although it was not known where the soldiers contracted the infections, the Army said the recent surge highlighted a need to improve infection control in military hospitals.

Frightening Perspective Flying ICU's save lives in Iraq For example, doctors, nurses and medics in Iraq worry far less about infection than they would at a hospital in the U.S., although the staff works to keep everything as clean as possible. The wounds themselves are often the filthy aftermath of bomb explosions. In addition, Iraq’s ever-present dust is always blowing, sometimes even into the operating room. When infections occur it is usually three or four days after an injury. By that time, the patient is thousands of miles away.

IDSA: Wounded Soldiers Back From Iraq With Multidrug-Resistant Acinetobacter Several different military research groups have been working on the problem from different angles, but all seem to have come to the same conclusion: Infection is occurring early in soldiers' post-injury medical care, most likely while still in Iraq.

Superbug brought back by Iraq War Casualties Experts in microbiology who were studying the links between the infection and those wounded in Iraq, said an injured soldier thought to have caught the infection in Iraq may have caused a large outbreak of the superbug in an intensive care unit in an NHS hospital in south-east England.

Prospective study of risk factors for ventilator-associated pneumonia caused by Acinetobacter species Previous use of ceftriaxone and ciprofloxacin are independent risk factors for the development of VAPA.

Multidrug-Resistant Acinetobacter Extremity Infections in Soldiers As previously noted, we initially suspected that colonized soldiers themselves were the reservoir for MDR Acinetobacter, and that this colonization was obtained from the environment. This hypothesis was based on 2 facts. First, these organisms are ubiquitous in the environment (4,25), and inoculation of these organisms into war wounds during traumatic blast, shrapnel, or projectile injuries seemed to be plausible. Second, Acinetobacter spp. had previously been described as common pathogens in war wounds (3), supporting the initial hypothesis. However, these infections are apparently similar to recently reported nosocomial MDR Acinetobacter infections. Investigation into the cause of these infections is ongoing, but the source is unlikely to be environmental. Multiple follow-up soil samples have not yielded Acinetobacter, yet it has been recovered from environmental cultures within field medical facilities. The final outcome of this investigation is pending further analysis.

Prof's Study Deadly Germ Found in Iraq A. baumannii, thought to reside in soil and water, can, if left untreated, cause pneumonia, meningitis, respiratory infections, sepsis and urinary tract infections. Upon infection, the organism has a casualty rate of 75 percent.

Multidrug-Resistant Acinetobacter Hitchhiking to US Military Hospitals With Wounded Soldiers The infections do have a clinical impact on patients, according to Dr. Scott's data, with infected patients requiring significantly longer hospital stays, more days in the intensive care, more days of antibiotic therapy, and more surgeries, compared with comparably wounded soldiers who are colonized with the bacteria but not carrying active infections.

Healing, With New Limbs and Fragile Dreams By JULIET MACUR February 12, 2006 Most of the amputees returning from combat zones have an infection, because a bomb blast can embed bacteria, dirt or pieces of clothing deep into the wound, Colonel Pasquina said. A severe infection could require further amputation or possibly be fatal.

What Makes Acinetobacter So Scary? by Mike the Mad Biologist Acinetobacter, We're All Going to Die Well, actually only about 30,000 per year, if we can extrapolate from the Israeli experience. One of the things   that makes Acinetobacter so dangerous is that it is multi- drug resistant. Today, the Washington Post  summarizes some Acinetobacter genomics work:  Acinetobacter baumannii is a bacterium that lives in soil and water. Thirty years ago, it rarely caused illness.  When it did, antibiotics killed it.  Today A. baumannii is a huge problem.  It is responsible for a prolonged outbreak of hospital-acquired infections in Europe. In some places,  mortality is as high as 25 percent, generally involving critically ill patients. Recently, the microbe was  implicated in a spate of wound infections in combat casualties in Iraq and Afghanistan.   Last week, French researchers shed light on what has made it such a microbial monster. Pierre-Edouard  Fournier of the Institute for Structural Biology and Microbiology in Marseille sequenced the genome of a  multidrug-resistant strain and compared it with an ordinary one. He and colleagues found an "island" of 45  antibiotic-resistance genes, the biggest collection ever found in a bacterium.  .... they deduced that 44 percent of the genes had been imported from Pseudomonas..., 34 percent from   Salmonella , 17 percent from Escherichia and 4 percent from other species. The "island" apparently formed   because a cluster of "mobile genetic elements" -- which allow genes to move among bacteria -- permitted  one strain to collect and warehouse the resistance genes of its neighbors. Having just finished reading the PLoS Genetics article, this island is screwy. An "island" refers to a large   chunk of DNA (typically anywhere from ~0.2% – 5% of the entire genome) that appears to have entered the  host genome via horizontal transfer (note: these islands often don't enter in one whole piece, but instead, in  smaller piece. Analysis of a pathogenicity island in E. coli suggests that there are multiple steps). Here's  some of the screwball things:  The multidrug resistant Acinetobacter has 52 resistance genes. Yes, 52. 45 of those 52 genes are found in this island. A very rough estimate (very rough) is that about 50% of the  DNA in the island encodes for a resistance genes, whereas in the rest of the genome, the figure is about  0.05%. A lot of these genes seem to do the same thing: for example, there are six sulfonamide resistance genes. I  don't know if all of them are expressed, or if having multiple copies is a way to increase resistance (six  copies potentially means six times as much gene product; this isn't far-fetched–'duplication as regulation'   actually happens quite often in the lab). It has both mercury and arsenic resistance operons, as well as genes for resistance to lead, cobalt, zinc,  and cadmium. Cadmium? I always thought cadmium killed just about everything. That's just a taste. Leaving aside the public health implications, this is an amazing bug. Several questions  come to mind:   Do the other multidrug resistant Acinetobacter have the same island? If they lack this particular island, has a different island inserted in the same place in the genome? Can we find variability within similar islands such that we could reconstruct the evolution and spread of this  island? Are those multiple gene copies functional? Did they arise via duplication or independent transfer events?  We definitely need to know more about this organism.  Update: One reason this island is so scary is that all of these resistance genes are physically linked (or  integrated). What this means is that selection for resistance to any single antibiotic (i.e., exposure to one  antibiotic) could maintain all of the other genes. I really think we can not get a handle on reversing the  problem of antibiotic resistance until we deal with the linkage issue.      Sunday, August 28, 2005 Acinetobacter baumannii: There's a New Bug in Town Influenza's bad enough, but now there's a bacterium to worry about: Acinetobacter baumannii. A. baumannii is a common bacterium that lives on and around humans and typically doesn't cause disease; it's also common in soil. It's a very hardy bug too: resistant to dessication, metabolically versatile, and such. When the opportunity presents itself (e. g., an open wound, an IV line, or catheter tube), it can cause an infection, particularly in immunocompromised patients. In the past, there have been several antibiotics that were effective against A. baumannii, but now, we're finding strains of A. baumannii that are resistant to all the standard antibiotics. In fact, the only antibiotic that works against these multi-drug resistant strains is colistin, which has serious side effects (although it is preferable to, um, death). In rare cases, even colistin doesn't work, meaning we have nothing left in the chamber (although I don't know if tigecycline works). Drug resistant A. baumannii first made the news when it started showing up in U.S. military hospitals. Currently, it's thought that many of these cases are due to contamination within the hospital or patient-to-patient spread, and not from primary infections that the soldiers enter into the hospital with. The CDC recommendations for treatment are: Identification of colonized and infected patients, combined with implementation of infection-control measures such as hand-hygiene and contact-isolation precautions, might help prevent transmission of this organism within medical facilities... Interventions recommended by military medical officials have included 1) institution of active surveillance of groin, axillary, and/or wound cultures for A. baumannii for all patients; 2) use of contact precautions for colonized or infected patients; and 3) increased availability and use of alcohol-based hand rubs. Translated into English, essentially, we've almost returned to the pre-antibiotic age: we can't treat it very effectively, so we try to limit its spread. This is easier said than done. According to a story in Nature Medicine (Aug. 11, 2005; italics mine): Drug-resistant A. baumannii has infected at least 240 US soldiers since 2003, and five seriously ill patients who shared wards with them became infected and died...Most worrying is the bacterium’s ability to evolve resistance to a broad range of antibiotics unusually quickly, leaving few treatments for those who succumb. Scientists do not understand how this happens, but they know that the microbe has many ways to acquire resistance genes. And some strains naturally contain enzymes that break down some antibiotics. Researchers are also studying how the bacterium can survive on dry surfaces, particularly plastics, for many weeks. This enables bacteria to hang around on wards even when strict hygiene is maintained. Another disconcerting thing to note is that the bacterium killed patients who didn't have the infection initially–the bacterium spread from patient to patient in the hospital. And this isn't just a problem in U.S. military hospitals. 24 hospitals in the UK have shut down wards because of A. baumannii. Latin America has also experienced serious trouble with it (and my next post on this subject will discuss Latin America further). Israel has had problems too (italics mine): Yehuda Carmeli, an infectious-disease physician at the Tel Aviv Sourasky Medical Center in Israel, describes the situation as “a real danger”. The bacterium is endemic in many wards in his hospital, surviving hygiene measures that have seen off MRSA [multidrug resistant Staphylococcus aureus]. Carmeli also speculates that the bacterium has become more virulent as it has acquired antibiotic resistance. “We have calculated that 40% of our patients who become infected with A. baumannii die because of it,” he says. Not four percent. Forty. This is an incredibly lethal rate of infection. Before panic sets in, remember that these are opportunistic pathogens: they need to get past your natural defenses (i.e., skin, other barriers, and the immune system). Unfortunately, we have an increasingly at-risk immunocompromised population. An increasingly elderly population that requires the occasional hospital stay and frequent skin breaches (IV, dialysis, catheters) is at risk (keep in mind that the soldiers in the U.S. hospitals weren't immunocompromised, although they had suffered severe trauma). Other at-risk groups include HIV patients and those using immunosuppresants (e.g., transplants, cancer patients). From what little I've heard (and I'll be at a conference in late September where hopefully I'll have more information), there isn't one 'über-strain' of multi-drug resistant A. baumannii. The good news is that there isn't a virulent form which is spreading because it's good at causing disease. The bad news is that these multi-resistant strains appear wherever broad-spectrum antibiotics are over-used: Petrucelli says that military field hospitals are particularly guilty of overusing antibiotics. Sterility is difficult to maintain, so doctors tend to throw broad-spectrum antibiotics at the wounded. “But this removes options later on,” he warns. This is natural selection in action, pure and simple. Maybe if we pretend evolution doesn't happen, the problem will go away...

Outbreak of Acinetobacter linked to wound care equipment 21 December – EurekAlert reported that infection control experts at The Johns Hopkins Hospital say tighter rules governing use of a hand-held, high-pressure, water-pumping tool to wash and clean wounds should be adopted to improve the safety of wound care.

Correspondence Corner: Name: Steve Silberman Hometown: San Francisco Thank you for citing my Wired article on antibiotic-resistant infections in US military hospitals, "The Invisible Enemy." While the Lt. Col. seemed to enjoy the story, he's painting with a pretty broad brush when he says that my story is "not news." For years, Defense Department spokesmen have been telling the press that the source of the bacteria in question, which has infected or colonized over 700 wounded US soldiers and killed at least five civilians in military hospitals, was the Iraqi soil. The Lt. Col. perpetuates this myth by referring to the bacteria as a "foreign bug," ostensibly from Iraq. In fact, as I point out in the article, the primary source of the infections was the US combat-support hospitals themselves. The proliferation of the mistaken notion that the source of the bacteria was Iraqi dirt leads not only to misconceptions about how drug-resistant organisms are created (and can be controlled), but to bad medical practice on the front lines, which creates more death and disease. In a recent article in the Canadian Medical Association Journal, a trauma surgeon in Afghanistan was quoted as saying his team was planning on building double doors in their field hospital to keep out desert sand contaminated with this organism -- though it does not live in the sand, as the DoD has known for at least a year and a half, while saying otherwise publicly. The fact that the same strains of acinetobacter causing the US military infections have now spread into civilian hospitals in Europe where wounded troops receive care -- resulting in the deaths of dozens of civilians in London -- is worth noting. I interviewed several parents of wounded US soldiers who were never told that their children were infected with a potentially dangerous organism, and thus did not protect themselves from carrying it out of the hospital into other institutions. In one case cited in my story, the mother of a Marine was not even told that her son had died of a bacterial infection, but that he had expired as a result of his war wounds. It took a VA investigation to uncover the truth. So while the association of war and disease is as old as war itself, and the evolution of drug-resistant organisms is a problem worldwide, I'm confident that my story of this particular pathogen, where it really came from, how it spread, and how this epidemic has been covered up by the DoD, was worthy of bringing to national attention. Stephen L. Silberman - May 16, 2007 The primary source of these infections was not "mysterious" to the investigators who conducted the Army's own investigation this outbreak in 2004-2005, led by Col. Bruno Petrucelli, the director of infection control at Walter Reed Army Medical Center. What is indeed mysterious is why that report (Epidemiological Consultation 12-HA-01JK-04) has never been made public. In fact, the Defense Department has known that these infections are nosocomially acquired for quite some time, despite many public statements to the contrary. In last August's issue of the Clinical Infectious Diseases journal, doctors at Brooke Army Medical Center said that ongoing investigations "tend to support nosocomial transmission" -- and yet, here we are, nearly a year later, back at the "mystery" stage. I am a senior writer for Wired magazine, and I published an in-depth feature story on these infections in our February issue. I invite MedPage readers to read it. There is a lot of new information in it that helps solve the alleged puzzle of where these infections are coming from -- and what the Defense Department has already done to reduce rates of infection. The Invisible Enemy http://www.wired.com/wired/archive/15.02/enemy.html

US Soldiers Bring Bug from Iraq “It’s the cause of recent hospital-based outbreaks and it’s very hard to eradicate.” said Paul Scott, MD, chief of epidemiology and threat assessment, Division of Retrovirology, Walter Reed Army Institution of Research, Washington, D.C. “Essentially, it’s being imported into our hospitals.”

Cause of drug-resistant wound infections among soldiers in Iraq down to hospitals not battlefield Wednesday May 23, 2007 An outbreak of drug-resistant wound infections among soldiers in Iraq likely came from the hospitals where they were treated, not the battlefield, according to a new study in the June 15 issue of Clinical Infectious Diseases, currently available online.

US Soldiers in Iraq fighting drug-resistant bacteria after injuries May 2007 Note:  This is two years after the military already confirmed that there was no AB in the soil in the Iraq and that the bacteria was coming from the field hospitals. "If skin carriage is not the source of A. calcoaceticus-baumannii complex infection, then the other possibility is that the bacteria contaminates the wounds after injury," explains Dr. Griffith. "This could happen while an injured soldier is awaiting treatment or in the hospital during or after receiving medical care."   "This observation refutes the concept that the bacterium is acquired prior to injury among soldiers deployed to Iraq," Dr. Griffith says. "In addition, this observation adds to the ever growing body of evidence implicating nosocomial transmission as the cause of the ongoing military outbreak."

Senator Craig Thomas a Victim of the Iraq War? He is suffering from infection Medical Waste at Ibn Sina Poor people searching for stuff in rubbish that can be recycled or sold do not know what they can contract in dumps. Bacterial or viral infections can be easily contracted from the waste disposed by hospitals and clinics," Kamel said, adding that medical waste disposal had become a problem throughout the country. Officials at the Ibn Sina Hospital in the northern city of Mosul, 390km north of Baghdad, said there had rubbish had not been collected for more than a week and that poor people had been going through plastic bags of medical waste.

Comparison of Acinetobacter Baumannii isolates from the United Kingdom and the United States that were associated with Repatriated Casualties of the Iraq Conflict  July 2006 In conclusion, at least one outbreak strain of A. baumannii, responsible for further infections in the hospitals concerned, is associated with soldiers returning to the United States or United Kingdom from Iraq

Wound care equipment linked to Acinetobacter outbreak February 2005 Subsequent culture testing of the open-space treatment room for performing the procedure showed widespread presence of A. baumannii on the disposable parts of the pulsatile lavage gun, including disposable tubing and suction canister, as well as on cleaned stretchers, the sink and nearby supply shelves.

U.S. soldiers returning with resistant Acinetobacter baumannii infections November 2005 Walter Reed officials have instituted isolation policies and universal precautions, such as wearing gowns, gloves and masks around positive patients. “All of these patients in the initial outbreak were severely wounded combat casualties who had either limb or life-saving surgery at field hospitals in Iraq before their evacuation

Antibiotic resistance of Acinetobacter baumannii isolates: data from Ibni Sina Hospital for the year 2002 Time for a little science perspective on the rare blood infection experienced by U.S. Troops returning from the battlefront.

Casualties of War: MSF Surgeons Treat Wounded Iraqis Drug-Resistant Infections Nearly half of the patients needing orthopedic procedures arrive in Amman with severe bone and wound infections, which are often resistant to multiple antibiotics. Unhygienic conditions in Iraqi hospitals and significant delays in receiving treatment make patients susceptible to infection. "We are receiving patients with very difficult infections from Iraq," says Dr. R. "In Iraq, the mismanagement and misuse of antibiotics all lead to the appearance of resistant bacteria. These bacteria are resistant to almost all antibiotics except one or two. And these are the new generation of antibiotics that are very expensive."

Dec 9, 2004 Injured soldiers from Iraq have also brought an epidemic of multidrug-resistant Acinetobacter baumanii infection to military hospitals. It is not known how this has occurred. No such epidemic appeared among soldiers from Afghanistan, and whether the drug resistance is being produced by antibiotic use or is already carried by the strains colonizing troops is still being debated. Regardless, data from 442 medical evacuees seen at Walter Reed showed that 37 (8.4 percent) were culture-positive for acinetobacter — a rate far higher than any previously experienced. The organism has infected wounds and prostheses and caused catheter-related sepsis in soldiers and, through nosocomial spread, in at least three other hospital patients. Medical evacuees from Iraq are now routinely isolated on arrival and

Funding Request from Tom Daschle Dec 10, 2003 Our soldiers in Iraq have been at risk of contracting wound infections from multi drug resistant organisms such as Acinetobacter.   Wound infections are not only life threatening they raise the probability that patients will require limb amputations.

Move over MRSA New Test for Acinetobacter baumanni This organism has received recent press attention because personnel wounded by IEDs or combat in the Middle East show an extraordinarily high incidence of MDR Acinetobacter infections. In addition, MDR Acinetobacter causes periodic outbreaks in hospitals and is much more difficult to treat or eradicate than MRSA. Some medical experts believe that Acinetobacter and similar organisms present a greater and more imminent threat than MRSA. Strains that remain susceptible to only one or two antibiotics are increasingly common. Acinetobacter baumaniii from Housefly's A new study funded by Orkin Pest Control, Atlanta, GA, [has shown] that common house flies carry bacteria that has been linked to meningitis. This is the first time the bacterium _Acinetobacter baumannii_ has been detected from flies. For pest professionals who perform fly control services, this study has significant public health ramifications. Health Officials warn hospitals of Afghan Bug Threat posed by highly resistant bacteria underlines lack of preparedness Federal authorities are warning hospitals across the country to beware of a highly drug resistant bacteria that wounded troops are bringing back from Afghanistan -- and that could inadvertently be spread to civilian patients.

Antibiograms of Multidrug-Resistant Clinical Acinetobacter baumannii: Promising Therapeutic Options for Treatment of Infection with Colistin-Resistant Strains Whole Article Multidrug-resistant Acinetobacter baumannii infection has presented a global medical challenge. The antibiograms of paired colistin-susceptible and -resistant strains revealed increased susceptibility of colistin-resistant strains to most tested antibiotics, including those that are active against only gram-positive bacteria. Synergy between colistin and rifampicin was observed in the colistin-susceptible strains. The ability to form biofilm in the colistin-resistant strains was significantly lower (P < .001) than in the parent strains. Our study provides valuable information for potential expansion of our current therapeutic options against colistin-resistant A. baumannii infection.

Survival of Acinetobacter baumannii on Dry Surfaces: Comparison of Outbreak and Sporadic Isolates Acinetobacter spp. are important nosocomial pathogens reported with increasing frequency in outbreaks of cross-infection during the past 2 decades. The majority of such outbreaks are caused by Acinetobacter baumannii.

Canadian Soldiers get Acinetobacter baumannii from field hospitals in Kandahar Afghanistan? Published August 14, 2007 These results suggest that the source of A. baumannii infection for these four patients was an environmental source in the military field hospital in Kandahar. A causal linkage, however, was not established with the ventilator. This study suggests that infection control efforts and further research should be focused on the military field hospital environment to prevent further multi-drug resistant A. baumannii infections in injured soldiers Superbug hits Canadian Soldiers injured in Suicide Bombing Last Updated Feb 23, 2006 The recovery of three Canadians wounded last month in Afghanistan has been slowed by battlefield bacteria infecting American troops in Iraq, CBC News has learned.

Rapid Development of Acinetobacter baumannii Resistance to Tigecycline A 53-year-old woman experienced a multidrug- resistant (MDR) Acinetobacter baumannii urinary tract infection 5 months after undergoing kidney and liver transplantation. The tigecycline minimum inhibitory concentration (MIC) for her A. baumannii isolate was 1.5 μg/ml; the patient received 2 weeks of therapy with intravenous tigecycline as a 100-mg loading dose followed by 50 mg every 12 hours, with no lapses in treatment and with resolution of the infection. Three weeks later, MDR A. baumannii was isolated from her sputum in the setting of clinical evidence of pneumonia, and tigecycline was restarted; the tigecycline MIC for the A. baumannii isolate was 2 μg/ml. At approximately the same time, the patient was found to have a paraspinal abscess and spinal osteomyelitis. Cultures of the abscess fluid grew A. baumannii with a tigecycline MIC of 24 μg/ml. A follow-up sputum culture again yielded A. baumannii, but with a tigecycline MIC of 24 μg/ml. Urine culture at that time also grew A. baumannii with a tigecycline MIC of 24 μg/ml. Clinicians should be aware that tigecycline MICs for A. baumannii isolates may increase during therapy with tigecycline after only brief exposure to the drug. Patients receiving tigecycline for Acinetobacter should be monitored for the development of clinical resistance, and isolates should be monitored for evidence of microbiologic resistance.

Iraqi Civiilans being treated in US Medical facilities are being infected with Acinetobacter baumanni then cut loose to civiian medical facilities that do not have the means to treat it. Iraqi Health System rife with problems By Kelly Kennedy ASAD, Iraq — At the 399th Combat Support Hospital in mid-July, a soldier carried an impossibly tiny, malnourished 5-year-old boy into the emergency room with a gunshot wound to the stomach. Every doctor and nurse’s face registered a flash of sorrow, but they immediately converged to treat him. After the child had gone through surgery, the sorrow returned as doctors talked about the next stage of treatment: the Iraqi health care system. “The Iraqi medical system was one of the best in the Middle East prior to the Persian Gulf War,” said Col. Paul Astphan, acting commander of the unit. “Now they look upon their care as God’s will. If someone lives, great. If not, it’s God’s will. That’s the Iraqi health care system.” Statistics show 96 percent of Americans who make it to military hospitals in Iraq survive. But though the Iraqi soldiers, police officers and civilians who come into American hospitals with the same life- threatening wounds will receive the same care, the civilian follow-up care — or lack thereof — could kill them.

Capt. Eric Departo, a nurse with the 399th Combat Support Hospital, works in the ICU monitoring a 5-year-old Iraqi child who was shot in the abdomen.

Mystery Pnuemonia Toll May be much higher Mark Benjamin Published on Wednesday, September 17, 2003 WASHINGTON -- Mysterious pneumonia-like illnesses and breathing problems appear to be striking U.S. troops in greater numbers than the military has identified in an investigation -- including more deaths, according to soldiers and their families.

Acinetobacter Links Acinetobacter FAQ's Report Cases of Acinetobacter baumannii