Published Date: 2003-04-17 23:50:00
Subject: PRO/EDR> Acinetobacter, drug resistant - Iraq: RFI
Archive Number: 20030417.0934
ACINETOBACTER, DRUG RESISTANT - IRAQ: REQUEST FOR INFORMATION
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Date: Thu, 17 Apr 2003 12:53:20 -0400
From: LCDR Kyle Petersen <KPetersen@COMFORT.NAVY.MIL> [edited]
Multidrug Resistant (MDR) Acinetobacter in Persian Gulf
------------------------------
I have seen several cases of MDR Acinetobacter amongst Iraqi natives wounded
by gunshots, shrapnel, burns or motor vehicle accidents. The isolates are
from blood, CSF or wound cultures drawn within 2 hours of arrival on our
hospital ship. Isolate senstivities by the Kirby-Bauer method are resistant
to ampicillin, ampicillin/sulbactam, TMP/SMX, gentamicin, cefoxitin,
cefazolin, cefotaxime, ceftazidime, ticarcillin, and ciprofloxacin but
sensitive to imipenem, amikacin and tobramycin.
Review of the literature from the Marmara earthquake and Vietnam war
suggests _Acinetobacter species_ are fairly common pathogens in traumatic
wounds, especially if they are dirty. The prior literature, however, does
not cite multidrug resistance as a problem.
Can anyone familiar with soil biology of Iraq or the drug prescribing
practices of the pre-regime medical system explain the severe drug
resistance pattern we are seeing among our trauma victims medevaced from
Iraq? Any comments would be greatly appreciated.
---
LCDR Kyle Petersen
Infectious Diseases
USNS Comfort TAH-20
Persian Gulf
<KPetersen@COMFORT.NAVY.MIL>
[It is interesting that the sensitivities of the reported isolates are
similar to those of the multiresistant Acinetobacter isolates not uncommonly
causing nosocomial infections in parts of the USA. The antibiotic
sensitivity pattern resembles that of extended spectrum
beta-lactamase resistance (ESBL). This can be confirmed by using a
beta-lactamse inhibitor on the plate to restore sensitivity to
third-generation cephalosporins. Even though some of these isolates
show some sensitivity to cephalosporins, they are best treated with a
carbapenem antibiotic such as imipenem. - Mods.LL&LM]
See Also
2002----
Gram negative bacilli, ESBL - UK (Scotland) 20020527.4333
2001
----
Acinetobacter baumannii from house flies 20010828.2041
Acinetobacter, drug-resistant - Turkey: correction 20010529.1041
Acinetobacter, drug-resistant - Turkey 20010524.1011
...................ll/lm
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