all oxidase-negative and grow on MacConkey agar except for CDC group NO-1 either oxidize or do not utilize glucose Although NO-1 is oxidase-negative and does not usually grow on MacConkey agar, it is included here because it must be distinguished from the asaccharolytic Acinetobacterspp.
EPIDEMIOLOGY
inhabit environmental niches Acinetobacter spp. and S. maltophilia being widely distributed in nature and hospital environments. relatively high prevalence of Acinetobacter spp. and S. maltophilia in hospitals frequently results in colonization of the skin and respiratory tract of patients
PATHOGENESIS AND SPECTRUM OF DISEASE
(**all organisms that will be discussed are opportunistic pathogens for which no definitive virulence factors are known.)
Acinetobacterspp. and S. maltophilia: relatively common colonizers of hospitalized patients clinical significance when found in patient specimens can be difficult to establish organisms are more frequently isolated as colonizers than as infecting agents **infection does occur, it usually involves debilitated patients, such as those in burn or intensive care units, who have undergone medical instrumentation and/or have received multiple antimicrobial agents. Infections caused by Acinetobacterspp. and S. maltophilia usually involve the respiratory or genitourinary tract, bacteremia, and, occasionally, wound infections, but infections involving several other body sites have been described Community-acquired infections with these organisms can occur, but the vast majority of infections are nosocomial.
LABORATORY DIAGNOSIS
SPECIMEN COLLECTION AND TRANSPORT (**No special considerations are required for specimen collection and transport of the organisms discussed in this chapter)
DIRECT DETECTION METHODS
(**no specific procedures for the direct detection of these organisms in clinical material.)
Acinetobacter spp. are plump coccobacilli that tend to resist alcohol decolorization; they may be mistaken for Neisseria spp. Bordetella spp. are coccobacilli or short rods S. maltophilia, P. oryzihabitans, and P. luteolaare short to medium size straight rods. CDC group NO-1 are coccoid to medium-size bacilli.
CULTIVATION Media of Choice
Also grow in 5% sheep blood and chocolate agars. also grow well in the broth of blood culture systems and in common nutrient broths such as thioglycollate and brain-heart infusion.
Incubation Conditions and Duration These organisms generally produce detectable growth on 5% sheep blood and chocolate agars when incubated at 35 C in carbon dioxide or ambient air for a minimum of 24 hours. MacConkey agar should be incubated only in ambient air.
COLONIAL APPEARANCE
APPROACH TO IDENTIFICATION
Acinetobacter spp. and S. maltophilia- reliably identified by the API 20E system (bioMrieux Inc., St. Louis, Mo) **most reliably identified using conventional biochemical and physiologic characteristics
Comments Regarding Specific Organisms There are 25 geno species or genomo species in the genus Acinetobacter Each genospecies comprises a distinct DNA hybridization group and is given a numeric designation, which has replaced previous species names. genus is also divided into two groups: contains the saccharolytic (glucose-oxidizing) species contains the asaccharolytic (nonglucose-utilizing) species Most glucose-oxidizing, nonhemolytic strains werepreviously identified as A. baumanii Most nonglucose-utilizing, nonhemolytic strains were designated as A. lwoffi. The majority of beta-hemolytic organisms were previously called A. haemolyticus Nitrate-reducing strains of asaccharolytic Acinetobacter spp. are difficult to differentiate from CDC group NO-1 **Acinetobacter transformation test provides the most dependable criterion for this purpose, but this test is not commonly performed in clinical microbiology laboratories. S. maltophilia - can produce biochemical profiles similar to those of Burkholderia cepacia, but a negative oxidase test most often rules out the latter - oxidizes maltose faster than glucose (hence the species name, maltophilia, (maltose loving) - produces a brown pigment on heart infusion agar that contains tyrosine.
ANTIMICROBIAL SUSCEPTIBILITY TESTING AND THERAPY: Acinetobacter spp. and S. maltophilia- exhibit resistance to a wide array of antimicrobial agents, making the selection of agents for optimal therapy difficult S. maltophilia- primary drug of choice: trimethoprim-sulfamethoxazole
PREVENTION:
**organisms are ubiquitous in nature- there are no recommended vaccination or prophylaxis protocols. Hospital-acquired infections are best controlled by following appropriate sterile techniques and infection control guidelines and by implementing effective protocols for the sterilization and decontamination of medical supplies.