Acinetobacter baumannii - another Hospital Acquired Infection to worry about

Early in 2007 an outbreak of Multiple Drug Resistant (MDR) Acinetobacter baumannii swept through Arizona - 236 cases in just 2 months. It was reported by the state disease monitoring systems, but ignored on the national level.

This outbreak spread nation wide and is related to returning injured sodiers from Iraq, and because of a legal technicality in reporting, the military and CDC will not discuss it publicly.

More people come forward, bit by bit, telling stories of how the hospital played down their infection. The one person who could have done something about it, "Rep. Dennis Moore" has walked away from the issue deciding it wasn't worth getting into even after what he had seen on a visit to Walter Reed. Acinetobacter baumannii infections among patients at military medical facilities treating injured U.S. service members in 2002-2004.

Acinetobacter is classified as an opportunistic pathogen. Healthy people are said to have their skin colonised on the surface of their skin with no ill effects. Newborns, the elderly, burn victims, patients with depressed immune systems, and those on ventilators, acinetobacter infections can and do kill.

Since Operation Iraqi Freedom began in 2003, more than 700 US soldiers have been infected or colonized with Acinetobacter baumannii. A significant number of additional cases have been found in the Canadian and British armed forces, and among wounded Iraqi civilians.

The Armed Forces Institute of Pathology has recorded seven deaths caused by the bacteria in US hospitals along the evacuation chain. Four were unlucky civilians who picked up the bug at Walter Reed Army Medical Center in Washington, DC, while undergoing treatment for other life-threatening conditions. Another was a 63-year-old woman, also chronically ill, who shared a ward at Landstuhl with infected coalition troops.

On result was a website dedicated to concerns about the disease in the military wounded which we drew attention to here -Saturday, March 31, 2007 Hospital Acquired Infections - A Bad News Day This site (now it appears discontinued) had collected press stories of which this was typical ..

Superbug hits Canadian soldiers injured in suicide bombing Thu, 23 Feb 2006

Master Cpl. Paul Franklin of Halifax lost a leg, Cpl. Jeffrey Bailey from Edmonton had devastating head injuries, and Pte. William Salikin of Grand Forks, B.C., also suffered a head injury.

The three soldiers were first taken to a U.S. military hospital in Landstuhl, Germany. When they left a week later, all three men were infected with drug-resistant bacteria.

Medical specialists aren't certain whether most infections started in the battlefield or
the hospital. It's thought that they may have gotten it from going through
the hospital in Landstuhl," said Lt.-Col. Henry Flaman, a Canadian military
doctor in Edmonton.

Now Professor Matthew Falagas of the Alfa Institute of Biomedical Sciences in Athens, Greece and Tufts University School of Medicine, Boston, Massachusetts speaking at a Society for General Microbiology 's 162 nd meeting in Edinburgh this week has highlighted the spread in the UK of this highly resistant organism and it's connection to the return of wounded soldiers adn their hspitalisation in the proximity of civilian patients.

It is also apparent that it doesn’t just cause severe infections, it kills many more patients than doctors had realised. Acinetobacter can cause pneumonia, skin and wound infections and in some cases meningitis.

In an alarming remark he said, “In some cases we have simply run out of treatments and we could be facing a pandemic with important public health implications”.

The connection with wounded comvbatants first became apparent after a 2003 outbreak aboard the U.S. hospital ship Comfort in the Persian Gulf, In May 2007 , a group of researchers narrowed the source of the infection down to field hospitals in Iraq and Kuwait, though some doctors and scientists still expressed doubts.

At first it was thought that the bacteria was pre-existing on the soldiers skin and migrated to wounds, but despite claims it can exist on the skin there was no evidence of prior infections and it appears that cross infection was happening.

What worries Professor Matthew Falagas is the fact that we are running out of anti-biotics to treat patients and that even old treatments such as colistin, a polymyxin type antibiotic discovered 60 years ago, no longer used because of serious side effects, has recently been used as a salvage remedy , have little use as bacteria like Acineobacter soon become resistant.

Acineobacter in the UK

Fiona McCrae in The Daily Mail today reports that 1,000 UK residents fall prey to Acineobacter every year (source ?) and whilst official figures are not available it was linked to 39 deaths at St. Mary's in Paddington, London 3 years ago when 101 patients tested positive October 2004 - June 2005. (Press release 15th June 2005)

In 2003 , 93 patients , 91 of them civilians became infected at Selly Oak Hospital, in Birmingham where servicement were controversially being treated in the same wards as civilian patients. They report that 35 of the infected patients died but it was not possible to establish if the Acineobacter infection was a main cause of death. (report Sunday Times Sun Oct 08, 2006 )

In January 2006 Margaret Berry, the hospital's chief nurse, said: "Acinetobacter is not uncommon in hospital intensive care units. We have identified just a small number of cases here at Addenbrooke's.