Uzma Tahseen, Muhammad Tahseen Talib


Background: Nosocomial infections caused by Acinetobacter species (Spp.) is an emerging threat in health care setups especially intensive care units (ICU). The objective of this observational study was to determine the pattern of Acinetobacter infections and its association with length of stay in patients admitted to our medical ICU from January to August 2011. Methods: All patients above 16 years of age with stay of more than 48 hours were checked for any development of new infections not present or incubating at the time of admission. Nosocomial infections were documented in the light of clinical findings and lab results. Data was analysed using statistical software SPSS 15.0. Results: A total of 146 patients had a stay of at least 48 hours; frequency of nosocomial infection was 30.8% out of which 57.8% were Acinetobacter infections. Respiratory system was most commonly involved. Acinetobacter Spp showed high resistance (96.2%) to penicillins, cephalosporins and even extended spectrum antibiotics including carbepenems, quinolones and piperacillin plus tazobactam. Extended drug resistance was seen in 92.3% isolates; while we found high susceptibility to tigecycline (88.5%) and polymyxins (100%). Acinetobacter Spp. infected patients had mean length of stay (LOS) of 12.92 days when compared to patients with other nosocomial infections and no infection with mean LOS of 7.05 days (p=0.05) and 4.86 days (p=0.00) respectively. Conclusions: Acinetobacter Spp infections increase with longer duration of stay in ICU. Emergence of multi-drug and extended-drug resistant Acinetobacter Spp is alarming and overwhelming at this rate for already stretched out health system with its economic and health implications.

Keywords: Acinetobacter, medical ICU, nosocomial Infection, multi-drug resistant, hospital acquired infection

Full Text:



Joyce M, Woods CW. Antibacterial susceptibility testing in the clinical laboratory. Infect Dis Clin North Am 2004;18(3):401–34.

Bergogne-Berezin E, Towner KJ. Acinetobacter Spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9(2):148–65.

Afzal-Shah M, Livermore DM. Worldwide emergence of carbapenem-resistant Acinetobacter Spp. J Antimicrob Chemother 1998;41(5):576–7.

Bonomo RA, Szabo D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa.Clin Infect Dis 2006;43:S49–56.

Villegas MV, Hartstein AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol 2003; 24(4):284–95.

Manikal VM, Landman D, Saurina G, Oydna E, Lal H, Quale J. Endemic carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000; 31(1):101–6.

Kidwai AA, Razzaq S, Jamal Q, Aatif S, Paracha S. Antibiotic resistance among gram negative bacilli causing ventilator associated pneumonia. Pak J Chest Med 2011;17(3):11–6.

Zafar A. Prevalent nosocomial gram negative aerobic bacilli and their antimicrobial susceptibility pattern in intensive care unit. J Pak Med Assoc 1999;49(7):169–72.

Mirza IA, Hussain A, Abbasi SA, Malik N, Satti L, Farwa U. Ambu bag as a source of Acinetobacter baumannii outbreak in an intensive care unit. J Coll Physicians Surg Pak 2011;21(3):176–8.

Clinical and Laboratory Standard Institute: Performance standards for antimicrobial susceptibility testing, Nineteenth informational supplement. CLSI document M100 S19.Wayne PA. USA 2009. (

Horan TC, Andrus M, Dudeck MA. CDC/NHSN Surveillance Definition of Healthcare-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting, Am J Infect Control 2008;36(5):309–32

Manchanda V, Sanchaita S, Singh N.. Multidrug Resistant Acinetobacter. J Glob Infect Dis 2010;2(3):291–304.

Malini A, Deepa E, Gokul B, Prasad S. Nonfermenting Gram-Negative Bacilli Infections in a Tertiary Care Hospital in Kolar, Karnataka. J Lab Physicians 2009;1(2):62–6.

Markogiannakis H, Pachylaki N, Samara E, Kalderi M, Minettou M, Toutouza M, et al. Infections in a surgical intensive care unit of a university hospital in Greece. Int J Infect Dis 2009;13(2):145–53.

Falagas ME, Karveli EA. The changing global epidemiology of Acinetobacter baumannii infections: a development with major public health implications.. Clin Microbiol Infect 2007;13(2):117–9.

Shaikh JM, Devrajani BR, Shah SZ, Akhund T, Bibi I. Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital. J Ayub Med Coll Abbottabad 2008; 20(4):37–40.

Rizvi MF, Hasan Y, Memon AR, Abdullah M, Rizvi MF, Saleem S, et al. Pattern of nosocomial infection in two intensive care units of a tertiary care hospital in Karachi. J Coll Physicians Surg Pak. 2007;17(3):136–9.

Chim H, Tan BH, Song C. Five-year review of infections in a burn intensive care unit: High incidence of Acinetobacter baumannii in a tropical climate. Burns 2007;33(8):1008–14.

Alvarez-Lerma F1, Palomar M, Insausti J, Olaechea P, Cerdá E, Castillo F,et al. Infections caused by Acinetobacter Spp. in critically ill ICU patients. Enferm Infecc Microbiol Clin 2005;23(9):533–9.

Falagas ME, Karveli EA, Siempos II, Vardakas KZ. Acinetobacter infections: a growing threat for critically ill patients. Epidemiol Infect. 2008;136(8): 1009–19.

Goel V, Hogade SA, Karadesai S. Ventilator associated pneumonia in a medical intensive care unit: Microbial aetiology, susceptibility patterns of isolated microorganisms and outcome. Indian J Anaesth. 2012;56(6):558–62.

Erdem I, Ozgultekin A, Inan AS, Dincer E, Turan G, Ceran N, et al. Incidence, etiology, and antibiotic resistance patterns of gram-negative microorganisms isolated from patients with ventilator-associated pneumonia in a medical-surgical intensive care unit of a teaching hospital in istanbul, Turkey (2004-2006).Jpn J Infect Dis 2008;61(5):339–42.

Latif S,Anwar MS, Ahmad I. Bacterial pathogens responsible for blood stream infection (BSI) and pattern of drug resistance in a tertiary care hospital of Lahore. Biomedica 2009;25:101–5. Available from:

Sunenshine RH1, Wright MO, Maragakis LL, Harris AD, Song X, Hebden J, et al. Multidrug-resistant Acinetobacter infection mortality Rate and length of hospitalization. Emerg Infect Dis 2007;13(1): 97–103.

Kempf M, Rolain JM. Emergence of resistance to carbapenems in Acinetobacter baumannii in Europe: clinical impact and therapeutic options. Int J Antimicrob Agents 2012;39(2):105–14.

Mishra SK, Rijal BP, Pokhrel BM. Emerging threat of multidrug resistant bugs - Acinetobacter calcoaceticus baumannii complex and Methicillin resistant Staphylococcus aureus. BMC Res Notes. 2013;6:98.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []