Importance of Acinetobacter spp.

Part of the Infectious Agents and Pathogenesis book series (IAPA)


An enormous number of bacterial species exist in nature and the human environment with important roles in natural chemical and biological cycles involved in the agricultural aspects of food and industrial activity. However, only a relatively limited number of microbes are recognized as important pathogens for humans and causes of clinical infections, including well-known species like Salmonella spp.,Streptococcus pyogenes, or Corynebacterium diphtheriae. Development of newer microbiologic techniques permitted significant changes in medicine over the last half century, including development of newer antibacterial agents, advanced surgical procedures and development of intensive care units (ICUs) in hospitals. New organisms have attained an increasingly greater attention of clinical microbiologists, biomedical researchers and clinicians, especially in the ICUs. These microbes are Gram-negative bacteria and have an important role in nosocomial infections. During the last few decades, Acinetobacter spp. have been implicated in a wide spectrum of infections, e.g., bacteremia, nosocomial pneumonia, urinary tract infections, secondary meningitis, and superinfections in burn patients. One of the most striking features of Acinetobacter spp. is their extraordinary ability to develop multiple resistance mechanisms against major antibiotic classes. They have become highly resistant to broad spectrum ß-lactams (third-generation cephalosporins, carboxypenicillins, and to carbapenems). They produce a wide range of aminoglycoside-inactivating enzymes and most strains are resistant to fluoroquinolones. Acinetobacter are now known to be important causes of nosocomial infections, a major problem confronting ICU clinicians and this is related to the severity of infections and development of multiple drug resistance by these organisms to major antibiotic classes. Therefore, it seems important to review the rapidly expanding knowledge and major characteristics about these important organisms and update previously published books (“The Biology of Acinetobacter”, edited by K.J. Towner, E. Bergogne-Bérézin and C.A. Fewson, 1991 Plenum Press” and “Acinetobacter, Microbiology, Epidemiology, Infections, Management, edited by E. Bergogne-Bérézin, M.L. Joly-Guillou, K.J. Towner, 1996 CRC Press).


Infective Endocarditis Nosocomial Infection Methicillin Resistant Staphylococcus Aureus Nosocomial Pneumonia Acinetobacter Calcoaceticus 



I am very grateful to Herman Friedman who assisted me in preparation of this chapter. I thank warmly Kevin Towner who has been a leader to me in the Acinetobacter research and has often helped me in organizing Acinetobacter meetings. I am especially grateful to Marie-Laure Joly-Guillou who collaborated with us in all experiments, projects and publications regarding Acinetobacter for over 20 years.


  1. Afzal-Shah M., Woodford N., and Livermore D.M. 2001. Characterization of OXA-25, OXA-26, and OXA-27, molecular classes D β-Lactamases associated with carbapenem resistance in clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother 45: 583–588.PubMedCrossRefGoogle Scholar
  2. Amyes S.G.B, and Young H.-K. 1996. Mechanisms of antibiotic resistance in Acinetobacter spp. – genetics of resistance. In Bérézin E., Joly-Guillou M.L., and Towner K.J. (eds.) Acinetobacter: Microbiology, Epidemiology, Infection, Management. Bergogne. CRC Press, New-York, Chap. 8, pp. 185–223.Google Scholar
  3. Ayats J., Corbella X., Ardanuy C., Dominguez M.A., Ricart A., Ariza J., Martin R., and Linares J. 1997. Epidemiological significance of cutaneous, pharyngeal and digestive tract colonization by multi-resistant Acinetobacter baumannii in ICU patients. J Hosp Infect 37: 287–295.PubMedCrossRefGoogle Scholar
  4. Bergogne-Bérézin E. 2001. The increasing Role of Acinetobacter Species as nosocomial pathogens. Curr Infect Dis Rep 3: 440–444.PubMedCrossRefGoogle Scholar
  5. Bergogne-Bérézin E., and Joly-Guillou ML. 1985. An underestimated nosocomial pathogen: Acinetobacter calcoaceticus. J Antimicrob Chemother 16: 535–538.PubMedCrossRefGoogle Scholar
  6. Bergogne-Bérézin E., Joly-Guillou ML., and Vieu JF. 1987. Epidemiology of nosocomial infections due to Acinetobacter calcoaceticus. J Hosp Infection 10: 105–113.CrossRefGoogle Scholar
  7. Bergogne-Bérézin E., and Towner KJ. 1996. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical and epidemiological features. Clin Microbiol Rev 9: 148–165.PubMedGoogle Scholar
  8. Borer A., Gilad J., Smolyakov S., Eskira S., Peled N., Porat N., Hyam E., Trefler R., Rieseberg K., and Schlaeffer F. 2005. Cell phones and Acinetobacter transmission.. Emerg Infect Dis 11: 1160–1161.PubMedGoogle Scholar
  9. Bouvet P.J.M., and Grimont P.A.D. 1986. Taxonomy of the genus Acinetobacter with the recognition of Acinetobacter baumannii sp. nov., Acinetobacter haemolyticus sp. nov., Acinetobacter johnsonii sp nov., and Acinetobacter junii sp. nov. and emended descriptions of Acinetobacter calcoaceticus and Acinetobacter lwoffi. Int J Syst Bacteriol 36: 228–240.CrossRefGoogle Scholar
  10. Brisou J., and Prévôt A.R. 1954. Etude de systématique bactérienne. Révision des espèce réunies dans le genre Achromobacter. Ann Inst Pasteur 86: 722–728.Google Scholar
  11. Buisson Y., Tran Van Nhieu G., Ginot L., Bouvet P., Shill H., Driot L., and Meyran M. 1990. Nosocomial outbreaks due to amikacin-resistant tobramycin sensitive Acinetobacter species: correlation with amikacin usage. J Hosp Infect 15: 83–93.PubMedCrossRefGoogle Scholar
  12. Bukhary Z., Mahmood W., Al-Khani A., and Al-Abdely H.M. 2005. Treatment of nosocomial meningitis due to a multidrug resistant Acinetobacter baumannii with intraventricular colistin. Saudi Med J 26: 656–658.PubMedGoogle Scholar
  13. Caputo R., Gelmetti C., and Cambaghi S. 1997. Severe self healing nail dystrophy in a patient on peritoneal dialysis. Dermatology 195: 274–275.PubMedCrossRefGoogle Scholar
  14. Chastre J., Trouillet J.L., Vuagnat A., and Joly-Guillou M.L. 1996. Nosocomial pneumonia caused by Acinetobacter spp. In Bergogne-Bérézin E., Joly-Guillou M.L., and Towner K.J. (eds.) Acinetobacter – Microbiology, Epidemiology, Infection, Management. CRC Press, New-York, Chap. 6, pp. 117–132.Google Scholar
  15. Chen M.Z., Hsueh P.R., and Lee L.N. 2001. Severe community acquired pneumonia due to Acinetobacter baumannii. Chest 120: 1072–1077.PubMedCrossRefGoogle Scholar
  16. Corbella X., Ariza J., Ardanuy C., Vuelta M., Tubau F., Sora M., Pujol M., and Gudiol F. 1998. Efficacy of sulbactam alone and in combination with ampicillin in nosocomial infections caused by multi-resistant Acinetobacter baumannii. J Antimicrob Chemother 42: 793–802.PubMedCrossRefGoogle Scholar
  17. Davis K.A., Moran K.A., McAllister C.K., and Gray P. 2005. Multi-drug resistant Acinetobacte extremity infections in soldiers. Emerg Ingect Dis 11: 1218–1224.Google Scholar
  18. De Bord G.G. 1939. Organisms invalidating the diagnosis of gonorrhea by the smear method. J Bacteriol 38: 119Google Scholar
  19. Dijkshoorn L. 1996. Acinetobacter – microbiology. In Bergogne-Bérézin E., Joly-Guillou M.L., and Towner K.J. (eds.) Acinetobacter – Microbiology, Epidemiology, Infection, Management. CRC Press, New-York, Chap. 3, pp. 37–69Google Scholar
  20. Dijkshoorn L. 2006. Two decades experience of typing Acinetobacter strains: evolving methods and clinical application. Antibiotics 8: 108–116.Google Scholar
  21. Drault J.N., Herbland A., and Kaidomar S. 2001. Pneumopathie communautaire à Acinetobacter baumannii. Ann Fr Anesth Réanim 54: 290–292.Google Scholar
  22. Fiérobe L., Lucet J.C., Decré D., Muller-Serieys C., Joly-Guillou M.L., Mantz J., and Desmonts J.M. 2001. An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 22: 35–40.PubMedCrossRefGoogle Scholar
  23. Garcia-Garmendia JL., Ortiz-Lyba, Garnacho-Montero J et al. 1999. Moratality and the increase of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med. 27: 1794–1799.PubMedCrossRefGoogle Scholar
  24. Garnacho-Montero J.L., Ortiz-Leyba C., Jimenez-Jimenez F.J., Barrero-Almondovar A.E., Garcis-Garmendia J.L., Bernabeu-Wittel M., Gallego-Lara S.L., and Madras-Osuna J. 2003. Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intra-venous colistin: a comparison with imipenem-susceptible VAP. Clin Infect Dis 36: 1119–1121.CrossRefGoogle Scholar
  25. Gerner Schmidt P., Tjernberg I., and Ursing J. 1991. Reliability of phenotypic tests for identification of Acinetobacter species. J Clin Microbiol 29: 277–282.Google Scholar
  26. Goncalves C.R., Vaz T.M., Araujo E., Boni R.D., Leite D., and Irino K. 2000. Biotyping, serotyping and ribotyping as epidemiologcal tools in the evaluation of Acinetobacter baumanii dissemination in hospital Units. J Med Microbiol 49: 773–778.Google Scholar
  27. Héritier. C., Poirel L., Lambert T., and Nordmann P. 2005. Contribution of acquired carbapenem-hydrolysing oxacillinases in carbapenem-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 49: 3198–3202.PubMedCrossRefGoogle Scholar
  28. Héritier, C., Poirel L., and Nordmann P. 2006. Cephalosporinase over expression as a result of insertion of ISAba1 in Acinetobacter baumannii. Clin Microbiol Infect 12: 123–130.PubMedCrossRefGoogle Scholar
  29. Herruzo R., Dela Cruz J., Fernandez-Acenero M.J., and Garcia-Cabarello J. 2004. Two consecutive outbreaks of Acinetobacter baumannii 1-a in a burn intensive care unit for adults. Burns 30: 419–423.PubMedCrossRefGoogle Scholar
  30. Horrevorts A., Ten Hagen G., Hekster Y., Tjenberg I., and Diskjioorn L. 1997. Development of resistance to ciprofloxacin in Acinetobacter baumannii strains isolated during a 20-month outbreak. J Antimicrob Chemother 40: 460–461.PubMedCrossRefGoogle Scholar
  31. Hunt J.P., Buechter K.J., and Fahry S.M. 2000. Acinetobacter calcoaceticus pneumonia and the formation of pneumatoceles. J Trauma-Inj Infect & Crit Care 48: 964–970.CrossRefGoogle Scholar
  32. Husni R.N., Goldstein L.S., Arroliga A.C., Hall G.S., Fatica C., Stoller J.K., and Gordon S.M. 1999. Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 115: 1378–1382.PubMedCrossRefGoogle Scholar
  33. Jimenez-Mejias M.E., Pachon J., Becerril B., Palomino-Nicas J., Rodriuez-Coacho A., and Revuelta M. 1999. Treatment of multidrug resistant Acinetobacter baumannii meningitis with ampicillin/sulbactam. Clin Infect Dis 24: 932–935.CrossRefGoogle Scholar
  34. Joly-Guillou M.L., and Brun-Buisson C. 1996. Epidemiology of Acinetobacter spp.: surveillance and management of outbreaks. In Bergogne-Bérézin E., Joly-Guillou M.L., and Towner K.J. (eds.) Acinetobacter – Microbiology, Epidemiology, Infection, Management. CRC Press, New-York, Chap. 4, pp. 71–100.Google Scholar
  35. Joly-Guillou M.L., Decré D., Herrman J.L., Bourdelier E., and Bergogne-Bérézin E. 1995. Bactericidal in-vitro activity of β-lactams and β-lactamase inhibitors, alone or associated, against clinical strains of Acinetobacter baumannii: effect of combination with aminoglycosides. J Antimicrob Chemother 36: 619–629.PubMedCrossRefGoogle Scholar
  36. Juni E. 1984. Genus III. Acinetobacter. Brisou and Prévot 1954. In Krieg N.R., and Hold J.G. (eds.) Bergey's Manual of Systematic Bacteriology.The Williams & Wilkins Co., Baltimore, vol. 1, pp. 303–307.Google Scholar
  37. Katragou A., and Roilides E. 2005. Successful treatment of multi-drug-resistant Acinetobacter baumanniii central nervous system infections with colistin. J Clin Microbiol 43: 4916–4917.CrossRefGoogle Scholar
  38. Koeleman J.G., Parleviet G.A., Dijskhoorn L., Savelkoul P.H., and Vandenbroucke-Grauls C.M. 1997. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition. J Hosp Infect 37: 113–123.PubMedCrossRefGoogle Scholar
  39. Kollef M.H., Sherman G., Ward S., and Fraser V.J. 1999. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115: 462–474.PubMedCrossRefGoogle Scholar
  40. Lai S.W., Ng K.C., Liu C.S,. Lai M.M., and Lin C.C. 1999. Acinetobacter baumannii bloodstream infection: clinical features and antimicrobial susceptibilities of isolates. Kaohsiung J Med Sciences 15: 406–413.Google Scholar
  41. Lam S.M., and Huang T.Y. 1997. Acinetobacter with tamponade in a patient with systemic lupus erythematosus. Lupus 6: 480–483.PubMedCrossRefGoogle Scholar
  42. Lambert T., Gerbaud G., Bouvet P., Vieu J.F., and Courvalin P. 1990. Dissemination of amikacin resistance gene aphA6 in Acinetobacter spp. Antimicrob Agents Chemother 34:1244–1248.PubMedGoogle Scholar
  43. Larson E., and Lusk E. 1985. Evaluating hand washing technique. J Adv Nurs 10: 547–552.PubMedCrossRefGoogle Scholar
  44. LaScola B., and Raoult D. 2004. Acinetobacter baumannii in human body louse. Emerg Infect Dis 10: 1671–1673.Google Scholar
  45. Lessel EF. 1991. International Committee on Nomenclature of Bacteria. Subcommittee on Nomenclature of Moraxella and Allied Bacteria. Int J Syst Bacteriol. 21:213–214.CrossRefGoogle Scholar
  46. Levi I., and Rubinstein E. 1996. Acinetobacter infections. Overview of clinical features. In Bergogne-Bérézin E., Joly-Guillou M.L., and Towner K.J. (eds.) Acinetobacter – Microbiology, Epidemiology, Infection, Management. CRC Press, New-York, Chap. 5, pp. 101–115.Google Scholar
  47. Levin AS., Barone AA., Penco J., Santos MV., Marinho IS., et al. 1999. Intravenous Colistin as Therapy for Nosocomial Infection Caused by Multi Drug Resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis. 28: 1008–1011.PubMedCrossRefGoogle Scholar
  48. Linde AS., Hahn J., Holler U., et al -2002. Septicemia due to Acinetobacter Junii. J.Clin.Micrrobiol. 49:2696–2697.CrossRefGoogle Scholar
  49. Lopez-Hernandez S., Alarcon T., and Lopez-Brea M. 1998. Carbapenem resistance mediated by beta-lactamases in clinical isolates of Acinetobacter baumannii in Spain. J Clin Microbiol infect Dis 17: 282–285.CrossRefGoogle Scholar
  50. Mc Donald L.C., Walker M., Carson L., Arduino M., Aguero S.M., Gomez P., Mc Neil P., and Jarvis W.R. 1998. Outbreak of Acinetobacter spp. bloodstream infection in a nursery associated with contaminated aerosols and air conditioners. Ped Inf Dis J 17: 716–722.CrossRefGoogle Scholar
  51. Mishra A., Mishra S., Jaganath G., Mittal R.K., Gupta P.K., and Patra D.P. 1998. Acinetobacter sepsis in newborns. Indian Pediatrics 35: 27–32.PubMedGoogle Scholar
  52. MMWR. Weekly 2004. Acinetobacter baumannii infections among patients at Military Medical Facilities Treating Injured US Service Members 2002–2004. 53: 1063–1066.Google Scholar
  53. Moreau N.J., Houot S., Joly-Guillou M.L., and Bergogne-Bérézin E. 1996. Characterization of DNA gyrase and measurement of drug accumulation in clinical isolates of Acinetobacter baumannii resistant to fluoroquinolones. J .Antimicrob Chemother 38: 1079–1083.PubMedCrossRefGoogle Scholar
  54. Mussi M.A., Limansky A.S., Viale A.M. 2005. Acquisition of resistance to carbapenems in multi-drug-resistant clinical strains of Acinetobacter baumannii: natural insertional inactivation of a gene encoding a member of a novel family of β-barrel outer membrane proteins. Antimicrob Agents Chemother 49: 1432–1440.PubMedCrossRefGoogle Scholar
  55. Nagels B., Ritter E., Thomas P., Schulte-Wissermann H., and Wirsing von Konig C.H. 1998. Acinetobacter baumannii colonization in ventilated preterm infants. Eur J Clin Microbiol Infect Dis 17: 37–40.PubMedCrossRefGoogle Scholar
  56. Nemec A., De Baere T., Tjernberg I., Vaneechoutte M., van der Rijden T.J.K., and Dijkshoorn L. 2001. Acinetobacter ursingii sp.nov. and Acinetobacter schindleri sp.nov., isolated from human clinical specimens. Int J Syst Evol Microbiol 51: 1891–1899.PubMedCrossRefGoogle Scholar
  57. Oncül O., Keskin O., Acar H.V., Küçükardali Y., Evrenkaya R., Atasoyu E.M. 2002. Hospital-acquired infections following the 1999 Marmara earthquake. J Hosp Infect 51: 47–51 (Acinetobacter Infections in military Personnel 2003–2004).
  58. Piéchaud, M. 1961. Le groupe Moraxella. A propos de B5 W-Bacterium anitratum. Ann Inst Pasteur 100: 74–85.Google Scholar
  59. Pillay T., Pillay DG, Adhikari M, Pillay et al. 1999. An outbreak of neonatal infection with Acinetobacter linked to contaminated suction catheters. J.Hosp.Infect. 43: 299–304.PubMedCrossRefGoogle Scholar
  60. Rodriguez-Hernandez M.J., Pachon J., Pichardo C., Cuberos L., Ibanez-Martinez J., Garcia-Curiel A., Caballero J., Moreno I., and Jimenez-Mijas M.E. 2000. Imipenem, doxycycline and amikacin in monotherapy and in combination in Acinetobacter experimental pneumonia. J Antimicrob Chemother 45: 493–501.PubMedCrossRefGoogle Scholar
  61. Schaub L.G., and Hauber F.D. 1948. A biochemical and serological study of a group of identical unidentifiable Gram-negative bacilli in human sources. J Bacteriol 56: 379–385.Google Scholar
  62. Seifert H., Strate A., Schulze A., Puverer G. 1993.Vascular catheter related bloodstream infection due to Acinetobacter jhnsonii (formerly Acinetobacter calcoaceticus var. lwoffi) report of 13 cases. Clin Infect Dis 17: 632–636.PubMedCrossRefGoogle Scholar
  63. Somerville D.A., Noble W.C. 1970. A note on the Gram-negative bacilli of human skin. Eur J Clin Biol Res 40: 669–670.Google Scholar
  64. Struelens M.J., Carlier E., Maes N., Serruys E., Quint W.G.V., and Van Belkum A. 1993. Nosocomial colonization and infection with multi-resistant Acinetobacter baumanii: outbreak delineation using DNA macrorestriction analysis and PCR- fingerprinting. J Hosp Infect 25: 15–32.PubMedCrossRefGoogle Scholar
  65. Taccone F.S., Rodiguez-Villalobos H., De Bcker D. 2006. Successful treatment of septic shock due to pan-resistant Acinetobacter baumannii using combined antimicrobial therapy including tigecycline. Eur J Clin Microbiol Infect Dis 25: 257–260.PubMedCrossRefGoogle Scholar
  66. Vila J., Marcos A., Marco F., Abdalla, S., Bergara, Y., Reig, R., Gomez-Lus, R., and Jimenez de Anta, T.. 1993. In vitro antimicrobial production of ß-lactamases, aminoglycoside-modifying enzymes, and chloramphenicol acetyltransferase by and susceptibility of clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother 37: 138–141.PubMedGoogle Scholar
  67. Villers M., Espaze E., Coste-Burel M., Giauffret F. et al. 1998. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. 129: 182–189.Google Scholar
  68. Weinbren M.J., Johnson A., Kaufmann M.E., and Livermore D.M. 1998. Acinetobacter spp. isolates with reduced susceptibilities to carbapenems in a UK burns unit. J Antimicrob Chemother 41: 574–576.PubMedCrossRefGoogle Scholar
  69. Wisplinghoff H., Perbix W., and Seifert H. 1999. Risk factors for nosocomial bloodstream infections due to Acinetobacter baumannii: a case-control study of adult burn patients. Clin Infect Dis 28: 59–66.PubMedCrossRefGoogle Scholar
  70. Wolff M., Brun-Buisson, C., Lode H.-1997. The changing epidemiology of severe infections in ICU. Clin Microb Infect (suppl) 3: S36–S47.Google Scholar
  71. Wolff M., Joly-Guillou M.L., Farinotti R., and Carbon C. 1999. In vivo efficacies of combinations of β-lactams, β-lactamase-inhibitors and rifampicin against Acinetobacter baumannii in a mouse pneumonia model. Antimicrob Agents Chemother 43: 1406–1411.PubMedGoogle Scholar
  72. Yu E.H., Ko W.C., Chuang Y.C., and Wu T.J. 1998. Suppurative thyroiditis with bacteremic pneumonia: case report and review. Clin Infect Dis 27: 1286–1290.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.“Antibiotiques Thérapeutiques Antiinfectieuses”France

Personalised recommendations