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Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges.
Clin Microbiol Rev. 2017 01; 30(1):409-447.CM

Abstract

Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)-Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed.

Authors+Show Affiliations

Division of Infectious Diseases, Keck School of Medicine of the University of Southern California (USC), Los Angeles, California, USA Darren.Wong@med.usc.edu.Division of Infectious Diseases, Keck School of Medicine of the University of Southern California (USC), Los Angeles, California, USA. Department of Molecular Microbiology and Immunology, Keck School of Medicine of USC, Los Angeles, California, USA.Departments of Medicine, Pharmacology, and Molecular Biology and Microbiology, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.Department of Molecular Microbiology and Immunology, Keck School of Medicine of USC, Los Angeles, California, USA.Division of Infectious Diseases, Keck School of Medicine of the University of Southern California (USC), Los Angeles, California, USA. Department of Molecular Microbiology and Immunology, Keck School of Medicine of USC, Los Angeles, California, USA.Division of Infectious Diseases, Keck School of Medicine of the University of Southern California (USC), Los Angeles, California, USA. Department of Molecular Microbiology and Immunology, Keck School of Medicine of USC, Los Angeles, California, USA. Los Angeles County-USC (LAC+USC) Medical Center, Los Angeles, California, USA.

Pub Type(s)

Journal Article
Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

27974412

Citation

Wong, Darren, et al. "Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges." Clinical Microbiology Reviews, vol. 30, no. 1, 2017, pp. 409-447.
Wong D, Nielsen TB, Bonomo RA, et al. Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clin Microbiol Rev. 2017;30(1):409-447.
Wong, D., Nielsen, T. B., Bonomo, R. A., Pantapalangkoor, P., Luna, B., & Spellberg, B. (2017). Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clinical Microbiology Reviews, 30(1), 409-447.
Wong D, et al. Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clin Microbiol Rev. 2017;30(1):409-447. PubMed PMID: 27974412.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. AU - Wong,Darren, AU - Nielsen,Travis B, AU - Bonomo,Robert A, AU - Pantapalangkoor,Paul, AU - Luna,Brian, AU - Spellberg,Brad, PY - 2016/12/16/entrez PY - 2016/12/16/pubmed PY - 2017/9/20/medline KW - Acinetobacter KW - Acinetobacter baumannii KW - Acinetobacter calcoaceticus SP - 409 EP - 447 JF - Clinical microbiology reviews JO - Clin Microbiol Rev VL - 30 IS - 1 N2 - Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)-Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed. SN - 1098-6618 UR - https://news.unboundmedicine.com/medline/citation/27974412/Clinical_and_Pathophysiological_Overview_of_Acinetobacter_Infections:_a_Century_of_Challenges. DB - PRIME DP - Unbound Medicine ER -