Acinetobacter baumannii-Associated Skin and Soft Tissue Infections: Recognizing a Broadening Spectrum of Disease

Abstract

Background: Acinetobacter baumannii is gaining importance as a cause of nosocomial infections, but its role in skin and soft tissue infection (SSTI) is not well defined. As a result of the outbreak of A. baumannii occurring in military personnel in Iraq and Afghanistan, reports of severe wound infections and SSTI caused by this pathogen are increasing in frequency. Methods: We describe four cases of monomicrobial and polymicrobial A. baumannii-associated necrotizing SSTI accompanied by A. baumannii bacteremia and offer a review of similar experiences published in the literature. Results: Our comparative analysis reveals four unique features associated with necrotizing SSTI associated with A. baumannii: i) Occurs in hosts with underlying comorbidities (e.g., trauma, cirrhosis); ii) is often accompanied by bacteremia; iii) multiple drug resistance and the presence of co-pathogens frequently complicated treatment (64% of cases); iv) the cases reported here and in our review required surgical debridement (84% of cases) and led to substantial mortality (*30%). Conclusions: As the prevalence of A. baumannii continues to increase in our health care system, SSTIs caused by this organism may become more common. Clinicians must be aware that the spectrum of disease caused by A. baumannii could include severe necrotizing SSTI and that vigilance for potential complications is necessary.

Biofilm Formation Caused by Clinical Acinetobacter baumannii Isolates Is Associated with Overexpression of the AdeFGH Efflux Pump

“…cinetobacter baumannii, an important and problematic opportunistic pathogen, is widely distributed in clinical settings (1,2), in which this bacterium often causes a wide range of infections, including bacteremia (3), pneumonia (4), meningitis (5), urinary tract infections (6), and wound infections (7). The treatment of Acinetobacter infections is becoming more difficult because nosocomial isolates are increasingly resistant to commonly used antimicrobial agents (8,9).…”

Acinetobacter baumannii resistente a carbapenémicos causando osteomielitis e infecciones en piel y tejidos blandos en hospitales de Medellín, Colombia

“…3) multirresistencia e infección con varios microorganismos en la mayoría de los casos, y 4) necesidad de tratamiento quirúrgico, y aumento de la mortalidad (20).…”

Are we closing in on an "elusive enemy"? The current status of our battle withAcinetobacter baumannii

“…This opinion lies in stark contrast to the reports of A. baumannii causing devastating necrotizing skin and soft tissue infections. 11,12 Genetic Factors that Permit the Success of A. baumannii…”

“…42 Such phenomena may explain the explosive clinical manifestations of A. baumannii, especially in cases of pneumonia and skin infections. A. baumannii is often associated with (usually) Gram-negative co-pathogens in necrotizing skin infections, 12 suggesting a plausible role for synergistic…”