The Epidemiology of Multidrug-ResistantAcinetobacter BaumanniiDoes the Community Represent a Reservoir?

Abstract

Acinetobacter isolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.8% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains of A. baumannii.

Molecular Characterization of Hand Flora and Environmental Isolates in a Community Setting

“…Among the GNR matched pairs, 29 were Acinetobacter species (52%), of which 15 A. baumannii and 14 Acinetobacter lwoffii isolates were found. The Acinetobacter strains were susceptible to the majority of antimicrobial agents tested, and results have been published elsewhere (37). The remaining GNR included 12 Enterobacter agglomerans, 2 Enterobacter cloacae, 9 Klebsiella pneumoniae, 3 Pseudomonas fluorescens/P.…”

“…Saiman et al recently reported that a virulent CA-MRSA strain had caused a nosocomial outbreak among postpartum women in our medical center (28), underscoring the importance of transmission of community strains in hospital settings. Nosocomial A. baumannii isolates, compared to those isolated from the community, have been shown to be multidrug resistant and clonally related (12,13,37), suggesting that the hospital environment serves as the reservoir for epidemic A. baumannii strains. Although A. baumannii isolates in the community are more drug susceptible, they also are clonal and could be encountered as potential pathogens within the hospital environment (37).…”

Ecological competition and the incidence of Acinetobacter baumannii bloodstream infections in a teaching hospital in Southeastern Brazil

“…The debate becomes more complex when A. baumannii 20 is considered. There are still gaps in our knowledge of the role of antimicrobial use, inanimate reservoirs, asymptomatic colonization and even continuous introduction from environmental sources outside healthcare settings 21,22 . In addition, the risk factors for the acquisition of drug-resistant A. baumannii isolates may vary with the extent of colonization pressure (i.e., the intensity of exposure to other patients harboring this agent) experienced by patients 12 .…”

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

“…45 Curiously, A. baumannii is a highly prevalent pathogen and colonizer in tropical, warm climates, whereas in temperate climates the reservoir of epidemic strains is located in hospitals and long-term care facilities. 6,[46][47][48] Researchers in the United States have documented a 17% increase in the monthly rate of A. baumannii infection for each 10 degrees F increase in temperature. 49 Even global warming conspires to favor A. baumannii!…”