College of Health Sciences
School of Medicine
DEPARTMENT OF MEDICAL MICROBIOLOGY,
PARASITOLOGY AND IMMUNOLOGY
Current Seminar Topics in Medical Microbiology
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Multi-drug Resistant Acinetobacter baumannii
PREPARED BY: GEMECHIS DEJENE
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Outline
Introduction
Epidemiology
Virulence factors and Pathogenesis
Clinical features
MDR Acinetobacter baumannii
Laboratory diagnosis
Prevention and Treatment
Future Therapeutic considerations
Conclusion and Recommendations
Reference
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Why A.baumannii ???
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CDC, Antibiotic resistance threats in the United States, 2019
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Introduction
Gram-negative coccobacillus, aerobic, non-fermentative
Non-fastidious
Size: 1 to 1.5 µm
Opportunistic pathogen
(Asif M et al., 2008)
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Introduction…
One of the six most significant multidrug-resistant, ESKAPE
“Bad bugs, No drugs, No ESCAPE!” (Boucher HW et al. 2009)
MDR-AB is a threat to global public health
More serious in low- and middle-income regions
(Lob SH et al., 2016)
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Figure 1: Brief history of the incorporation of Acinetobacter
baumannii as one of the successful multidrug-resistant (Ana Maria G et al. 2016)
nosocomial pathogens.
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Epidemiology
Natural habitats:
I. Environment
Soil
Water
Plants (vegetables, fruits)
(Houang ETS et al., 2001; Yigrem C et al., 2021)
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Epidemiology…
II. Hospital environments
Surfaces
Medical devices, and
Healthcare workers' hands
(Houang ETS et al., 2001; Yigrem C et al., 2021)
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Epidemiology…
Varying levels of prevalence across different regions
Relatively higher in developing nations
In different African countries, ranges from 10% to over 80%
(Almasaudi SB et al. 2016, Agyepong N et al. 2023)
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MDRAB rates were lowest in
NA(47%), ranged 77% - 87%
in Africa, Asia and LA, and >
93% in Europe and the
MiddleEast
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Sub-Saharan Africa
Figure 2: Reports of A. baumannii infections in
LICs in Sub-Saharan Africa from 2000 to 2020.
(Rizk SS et al. 2021)
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MDRAB and CRAB In Low-Income countries
Figure 3: The contributions of the different
LICs to the total number of MDR (A) and
the CRAB (B)
(Rizk SS et al. 2021)
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A.baumannii Antibiotic resistance in
Ethiopia
Fig.4: AMR of Acinetobacter
strains isolated from empirically
treated and untreated patients
referred from health facilities to
EPHI, 2014–2018.
(Ayenew Z et al. 2021)
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Fig 7. Trend of
Ampicillin (86% to 92%), antimicrobial resistance
Amoxicillin-clavulanate (81% to 84.7%) of A. baumanni from
Chloramphenicol (76% to 82.3%), and 2017 to 2021, Ethiopia.
Cefotaxime (66.7% to 82.2%)
Tobramycin (61.1-25.2%)
Tazobactam (84.6-63.2%)
Amikacin (31.6-26.2%)
(Araya S et al. 2023)
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Virulence Factors and Pathogenesis
Virulence factors Pathogenesis
Porin (OmpA) Adherence and invasion, induction of
apoptosis, serum resistance, biofilm formation
Capsular polysaccharide Growth in serum, survival in tissue infection,
biofilm formation
Lipopolysaccharide (LPS) LPS stimulates host immune responses,
leading to the release of cytokines and
chemokines
Type VI protein secretion Killing of competing bacteria, host colonization
system
Iron acquisition system In vivo survival, killing of host cells
Fimbriae Bacterial colonization, biofilm formation
Pili and adhesins Adhere to host cells and tissues
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Risk factors
Prolonged stay in a healthcare facility
Exposure to invasive medical procedures
Immunosuppression
Crowded living conditions
Use of broad-spectrum antibiotics
(Agyepong N et al., 2023)
Close contact with an infected person
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Clinical features of Acinetobacter
baumannii Infection
It is an opportunistic pathogen
Wide range of infections in hospitalized and
immunocompromised individuals
Rare community acquired infections
(Almasaudi SB.et al., 2016; Whiteway C et al. 2022; Fariba Akrami et al., 2019)
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Clinical features…
Hospital and Community-acquired Acinetobacter pneumonia
Bacteremia
Trauma and other wound infection
Meningitis
Endocarditis
(Almasaudi SB.et al., 2016; Whiteway C et al.
2022; Fariba Akrami et al., 2019)
Urinary tract infection
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Multidrug resistant
MDR Acinetobacter spp. -resistant to a minimum of three
classes of antimicrobial drugs:
• Penicillins and cephalosporins, fluoroquinolones, and
aminoglycosides
(Almasaudi SB et al. 2018; Elbehiry A et al., 2023)
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Multidrug resistant…
MDR Acinetobacter strains which show additional resistant to
Carbapenems, XDR
PDR Acinetobacter spp. is a XDR + resistance to polymyxins and
tigecycline
(Almasaudi SB et al. 2018; Elbehiry A et al., 2023)
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Multidrug resistant…
In Ethiopia, Acinetobacter species resistance rate are:
Piperacillin/tazobactam (85.5%),
ESCe(ceftazidime 94.6%, ceftriaxone 94.1%, and cefepime
90%)
Aminoglycosides (amikacin 31.5%, and tobramycin 51.7%)
Carbapenems (imipenem 59%) (Abdeta A et al. 2023)
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(Asif M et al. 2018)
Fig 8. Different mechanisms of antibiotic resistance in A. baumannii
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Laboratory diagnosis
Isolation and identification of the bacterium from clinical
specimens:
Blood
Sputum
Wound swabs
Urine
Cerebrospinal fluid
(Fariba Akrami et al., 2019)
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Laboratory diagnosis…
1. Gram stain: Gram-negative coccobacillus
2. Culture: on blood agar, MacConkey agar or Chocolate agar.
Smooth, non-hemolytic, glistening, and slightly mucoid
3. Biochemical tests: non-fermenting, oxidase and catalase
positive
(Fournier PE et al., 2006; Fariba Akrami et al., 2019)
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Laboratory diagnosis…
4. Molecular techniques: PCR, DNA sequencing, and
MALDI-TOF mass spectrometry
5. Antibiotic susceptibility testing
(Fournier PE et al., 2006; Gozdas HT et al. 2012)
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Prevention and control…
Fig 9. Measures which should be necessary implemented to
combat an A. baumannii infection (Fournier PE et al. 2006)
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Treatment
Imipenem is the most potent agent in comparison to
meropenem, for the treatment of multidrug-resistant strains
Tigecycline, a new glycylcyclines agent has bacteriostatic
activity against multidrug-resistant Acinetobacter species
(Viehman JA et al., 2014)
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Future Therapeutic Considerations
Future therapeutic considerations for A. baumannii infections:
Development of novel antibiotics
Repurposing of existing drugs
Alternative therapies
Combination therapies
Development of vaccines
(Fournier PE et al. 2006, Tu Q et al. 2023)
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Recommendations
Establishing antibiotic stewardship programs
Conducting regular surveillance
Conducting further research
Exploring non-antibiotic treatments
Implementing infection prevention and control measures
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Conclusion
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“I don’t want to say to my children that I didn’t do
my best to protect them and their children from
super bugs!”
“If we don’t act now, our medicine cabinet will be
empty and we won’t have the antibiotics we
need to save lives!”
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THANK YOU
