Multidrug-Resistant (APIC)

Volunteering to sign up for the military, a person usually knows the possibility of going to war, as well as, getting hurt severely. The last thing he/she thinks of is being affected by what could be a fatal nosocomial pathogen from the same facilities saving lives. Most nosocomial pathogens are transmitted during an extended hospital stay, by coming in contact with an infected object/person. They have also become multidrug-resistant (MDR) organisms, making them a serious threat to human health. The MDR Acinetobacter baumannii (Ab, abbreviated according to the Associations for Professional in Infection Control and Epidemiology, or APIC) has found its way into the combat field hospitals during the Iraqi War. From there, soldiers are coming home

spreading Ab to other health care facilities around the United States. At this moment, the government is working diligently to control Ab from spreading further by implementing strict regulations for handling Ab, as well as, creating new medical technology.
Before the war in Iraq, there was not much known about how to control and/or eradicate Ab within the United States, because it was not a common MDR infection.

Since the year of 2002, the year when soldiers first started to return from Iraq, Ab has become one of the most clinically significant MDR’s. APIC defines MDR Ab as:
Multidrug resistance to more than two of the following drug classes: antipseudomonal cephalosporins (ceftazidime or cefepime), antipseudomonal carbapenems (imipenem or meropenem), ampicillin/sulbactam, fluoroquinolones (ciprofloxacin or levofloxacin), and aminoglycosides (Gentamicin, tobramycin, or amikacin) (Rosenbaum et al. 7).
The history of Ab starts when “the Dutch microbiologist, Beijerinck, first isolated the bacteria from soil using minimal media enriched with calcium acetate, in 1911” (Aoife et al. 244). From there different characteristic of Ab were noted, such as, “Ab is often found in pairs, does not use oxygen, does not produce nitrites, does not move, and it can be isolated on a MacConkey agar, which is a specific media of petri dish” (Rosenbaum et al. 10). Using a staining method, it is determined that Ab is a gram-negative bacterium, because it does take on the stain. Although, Ab can be difficult to de-stain, making it harder to distinguish between gram-negative or positive (Aoife et al 244). “It also has the ability to survive longer in any environment, even on dry surfaces, because it is resistance to desiccation, or being completely deprived

of moister. Ab can multiply on human and animal skin, soil, and water giving it a diversity of places to survive, or reservoirs” (Joshi and Litake 27).
With the rapid spread of Ab, it is considered a community infection as well as a nosocomial infection. “Within the community, noted only in Australia in areas of a high number of alcoholism, Ab infection spreads through throat carriage. The main source of an Ab nosocomial infection is Intensive Care Units (ICU’s) at hospitals and long term care facilities. These units normally hold patients with extremely weakened immune systems, which is the primary target of Ab. Infections are usually caused by poor hygiene practices and cleaning of health care materials” (Aoife et al. 248). “Colonization sites on the body include the respiratory tract, blood, battlefield wounds, pleural fluid, urinary tract, surgical wounds, skin, eyes, and the central nervous system (CNS)” (Aoife et al. 244). As a bacterium that resembles myelin, a formation of protein that protects nerves, “Ab has been further studied as a cause of Multiple Sclerosis. Ab antibodies have been found in patients, including soldiers who fought in Iraq, Multiple Sclerosis (MS)” (Ebringer 138-140).
“There are many symptoms of Ab that vary from patient to patient, and with the different approaches to studying this infectious disease, there is a lack of consensus on what type of symptoms it produces. Through these studies, Ab has been linked to ventilator associated pneumonia (VAP), and in battle wounds the skin shows a “peau d’orange” appearance (making the human skin pitted like an orange peel). It has also been noted that post-neurosurgical (brain surgery) Ab meningitis is also becoming a common symptom” (Aofie et al. 247-248). Needing to further their knowledge of Ab, the government and scientists are being force to accelerate their research with a significant amount of cases being reported in the military.