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Overview of glucose nonfermenters

Acinetobacter

• 32 spp
• 15 Species cause human infection:

<aside> 💡

Acinetobacter calcoaceticus–baumannii complex, includes:

• Acinetobacter baumannii
• Acinetobacter pittii
• Acinetobacter nosocomialis
• Acinetobacter calcoaceticus </aside>

| Site | - Environment (Soil, Water)

• Fomites (good @ colonising wet surfaces, resistant to some disinfectants)
• Colonised HCWs (Wet skin) —> ITUs | | --- | --- | | Risk Factors | Hospital
• ITU admission / Stormy admissions
• Lines
• TPN
• ABx

Community

• Lung disease (Esp in smokers)
• Alcoholic
• Diabetes mellitus
• Tropical regions (common cause LRTI) | | Pathogenic mechanisms | Not v pathological; mostly causes nosocomial illness | | Clinical syndromes | - Chest: o VAP/HAP (NB: 80% isolates are MDR) o CAP (tropical) o Tracheobronchitis (child)
• CAUTI
• CNS infection (Esp if prosthetic material e.g. VAD)
• SSTI o Burns o PWID
• BSI (normally from chest or IV line) |

Lab diagnostic

• Bug:
  • GNB – but Gram variable
  • Short plump coccobacilli
  • Many are capsular
  • Nonmotile
  • Ox- / Cat+
• Agar: Aerobic
• Colony:
  • Yellow to greyish white
  • Mucoid
  • haemolyticus = haemolytic on blood agar
• Species ID
  • Biochemical: Ox- GNB, glucose nonfermenting
  • MALDI
  • PCR:
    • 16S RNA PCR
    • GyrB gene
  • WGS

SMI Flowchart for Nonfermentor identification

Treatment

1. Beta-lactams:
   • Sulbactam (Either Amp-Sulb or Sulb-Durlo)
   • PipTaz
   • Cefotax/Ceftriax/Ceftaz, Cefepime
   • Cefiderocol
   • Carbapenem (Not Erta)
2. Tetracyclines (Doxy, Mino)
3. Aminoglycosides
4. Quinolone (Cipro, Levo)