<i>Acinetobacter</i>co-infection and coagulase-negative<i>Staphylococcus</i>: case report and literature review

Elsürer, Rengin; Afsar, Barış

doi:10.3109/08860221003664264

Renal Failure

2010

DOI: 10.3109/08860221003664264

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Acinetobacterco-infection and coagulase-negativeStaphylococcus: case report and literature review

Rengin Elsürer¹,

Barış Afsar²

Abstract: Continuous ambulatory peritoneal dialysis (CAPD) is a safe, convenient, and cost-effective therapy in endstage renal disease. The major complication of peritoneal dialysis (PD) is peritonitis. Gram-positive cocci are isolated in majority of the episodes. Among gram-negative bacteria, Acinetobacter species have been reported in peritonitis, sometimes as a concomitant that may be asymptomatic and require no treatment. Little has been written about the clinical features and outcome of PD-related peritonitis cause… Show more

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Cited by 3 publications

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“…Being a member of the SPICE (Serratia, Pseudomonas/Providencia, indole-positive Proteus/Acinetobacter/Morganella, Citrobacter, Enterobacter or Hafnia) family, Acinetobacter is also inherently more resistant to beta-lactam antibiotics due to inducible chromosomally mediated beta-lactamases (10,11). But studies on Acinetobacter PD-related peritonitis have been scarce, with most being restricted to case reports or case series (10,(12)(13)(14)(15)(16)(17)(18). A recent Taiwanese study reported an increase in the incidence of Acinetobacter-associated peritonitis (18).…”

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confidence: 99%

Epidemiology and Clinical Characteristics of Acinetobacter Peritoneal Dialysis-Related Peritonitis in Hong Kong—with a Perspective on Multi-Drug and Carbapenem Resistance

Cheng

Yip

et al. 2017

Perit Dial Int

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♦ BACKGROUND: spp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies on peritonitis have been scarce. In view of the rising concern of carbapenem-resistant (CRA) and multidrug-resistant (MDRA) infections, we conducted this study on the incidence of peritonitis and the impact of CRA and MDRA on its outcome. ♦ METHODS: We retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients with PD-related peritonitis. ♦ RESULTS: Out of 2,389 episodes of peritonitis, there were 66 episodes (3%) of peritonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85, = 0.006) and carbapenem resistance (OR = 18.2, = 0.049) were significantly associated with higher rates of treatment failure. ♦ CONCLUSION: Both carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority of isolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.

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Epidemiology and Clinical Characteristics of Acinetobacter Peritoneal Dialysis-Related Peritonitis in Hong Kong—with a Perspective on Multi-Drug and Carbapenem Resistance

Cheng

Yip

et al. 2017

Perit Dial Int

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“…Similar to S. aureus, A. baumannii has been implicated in a variety of polymicrobial infections (20)(21)(22)(23). Although it is difficult to quantify the incidence of coculturing S. aureus and A. baumannii clinically, the two pathogens have been coisolated from diabetic foot infections (24)(25)(26), pneumonia (6,27,28), bacteremia (29), and other sites of infection as well (30,31). A previous study reported that A. baumannii strains are capable of protecting other Gramnegative pathogens from b-lactam exposure, but the extension of this protective effect to S. aureus remains unexplored (32).…”

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Interaction of Staphylococcus aureus and Acinetobacter baumannii during In Vitro β-Lactam Exposure

Smith

Ang

Tan

et al. 2021

Antimicrob Agents Chemother

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We sought to determine if Acinetobacter baumannii is capable of altering the pharmacodynamics of an anti-staphylococcal β-lactam. Two strains of methicillin-susceptible Staphylococcus aureus (MSSA) and two A. baumannii isolates were studied in 24-h static time-killing experiments in monoculture or co-culture conditions. Bacterial killing of meropenem was described using an empiric pharmacokinetics/pharmacodynamics model that was developed using Hill functions. A mechanism-based pharmacodynamic model was also used to describe the effect of meropenem on each species of bacteria, inter-species interactions, and strain-based covariate effects. Monte Carlo simulations of bacterial killing effects were generated based on the population pharmacokinetics of meropenem in 2500 simulated critically ill subjects over 48h. Against one of the two MSSA isolates, the magnitude of bacterial killing (Edelta) decreased from -4.61 (95%CI -5.85 – -3.38) to -2.23 (95%CI -2.85 – -1.61) when cultured in the presence of carbapenem-resistant A. baumannii (CRAB). Similarly, the data were best described by a mechanism-based model where the number of A. baumannii cells produced a systematic increase in the S. aureus KC50 3.53-fold, thereby decreasing MSSA sensitivity to meropenem. A covariate effect by the CRAB resulted in a more pronounced increase in MSSA KC50 to meropenem (31.8-fold increase). However, Monte Carlo simulations demonstrated that a high intensity meropenem regimen is capable of sustained killing against both MSSA isolates despite the protection from A. baumannii. Thus, A. baumannii and MSSA engage in complex interactions during β-lactam exposure, but optimal antimicrobial dosing is likely capable of killing MSSA despite potentially beneficial interplay with A. baumannii.

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Successful Treatment of Extensively Drug-Resistant Acinetobacter baumannii Peritoneal Dialysis Peritonitis with Intraperitoneal Polymyxin B and Ampicillin-Sulbactam

et al. 2012

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P eritonitis is a serious complication of peritoneal dialysis (PD). The mortality rate associated with PD peritonitis is estimated to be 4%, and this complication is identified as a contributing factor in 16% of peritoneal dialysis-related deaths. 1 Rates of PD peritonitis have been decreasing since the early 1990s; however, the relative proportion of peritonitis episodes caused by gram-negative bacteria is increasing. 2,3 Gram-negative PD peritonitis is associated with increased rates of catheter loss, hospitalization, switch to hemodialysis, and mortality. 3-5 Although Pseudomonas aeruginosa, Escherichia coli, and Klebsiella spp. are the most common causes of gram-negative PD peritonitis, Acinetobacter spp. are also frequently isolated pathogens. 2-4 In a review of PD peritonitis from Singapore, Acinetobacter spp. was the most commonly isolated gramnegative bacteria; however, this was a single-center experience and the microbiologic trend may not be applicable to other centers. 5 Acinetobacter baumannii is recognized as an important and increasingly drug-resistant nosocomial pathogen. 6 As a result of this species' ability to resist desiccation and disinfectants, colonize the skin, and form biofilms, A. baumannii is particularly well adapted to infect foreign material. 7 Multidrug-resistant (MDR) strains, commonly defined as resistant to at least 3 classes of antibiotics, and extensively drug-resistant (XDR) strains, defined as susceptible only to the polymyxins, have been implicated primarily in health care-associated infections and nosocomial epidemics. 7 To date, there are no published reports of successful treatment of nosocomial MDR or XDR Acinetobacter PD peritonitis. We present a case of XDR A. baumannii PD peritonitis successfully treated with a combination of intraperitoneal polymyxin B and ampicillin-sulbactam.

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Acinetobacterco-infection and coagulase-negativeStaphylococcus: case report and literature review

Cited by 3 publications

References 2 publications

Epidemiology and Clinical Characteristics of Acinetobacter Peritoneal Dialysis-Related Peritonitis in Hong Kong—with a Perspective on Multi-Drug and Carbapenem Resistance

Epidemiology and Clinical Characteristics of Acinetobacter Peritoneal Dialysis-Related Peritonitis in Hong Kong—with a Perspective on Multi-Drug and Carbapenem Resistance

Interaction of Staphylococcus aureus and Acinetobacter baumannii during In Vitro β-Lactam Exposure

Successful Treatment of Extensively Drug-Resistant Acinetobacter baumannii Peritoneal Dialysis Peritonitis with Intraperitoneal Polymyxin B and Ampicillin-Sulbactam

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