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Preying on the sick

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'The patients we see with Acinetobacter infections are frequently in the hospital for extended periods of time, often more than a couple of weeks," says Titus Daniels, M.D., a third-year fellow in infectious diseases. "Many are burn and trauma patients who have had prior surgical procedures – open surgical procedures, in-dwelling central catheters or tracheostomies."

Daniels said the infections caused by Acinetobacter are frequently resistant to the common types of antibiotics used to treat the infections – piperacillin, ampicillin and the cephalosporins.

And now even reserve antibiotics that have a known success for treating these infections – in this case imipenem and meropenem – aren't working, and new antibiotics to treat resistant bacteria won't be available for years.

Daniels says that although infections from the bacteria are increasing, the CDC doesn't have official numbers on the frequency of the occurrence. "It hasn't crossed the threshold to be routinely reported, but it will probably be in a CDC future report since it's increasing and interest in Acinetobacter has also increased."

There is some evidence that patients with Acinetobacter infections have an increased rate of mortality, but more study is needed, Daniels says. A retrospective Vanderbilt study is looking into various aspects of what happens in patients with Acinetobacter infections: the epidemiology – what types of patients get the infections, what the risk factors are, and how long they were in the hospital before acquiring the infection; the outcomes – if patients with pneumonia and Acinetobacter infection fare worse than patients with pneumonia only; and the cost of caring for these patients.

The study involves about 200 patients who have been treated at Vanderbilt in the SICU and trauma and burn units, and a group of uninfected patients as well. It utilizes data obtained through the Medical Center's financial database, about the types of procedures and costs associated with those procedures.

Preventing Acinetobacter infections is still the key focus. "As with other health care-associated infections the most important things we can do are those things we know reduce infections – good hand hygiene practices, minimizing procedures, and removing devices such as breathing tubes, intravenous and bladder catheters as soon as possible. Basic infection-control and prevention practices remain the most effective tools for preventing health care -associated infections." VM

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