Tilley P A, Roberts F J
Division of Medical Microbiology, University of British Columbia, Vancouver, Canada.
Clin Infect Dis. 1994 Jun;18(6):896-900. doi: 10.1093/clinids/18.6.896.
Acinetobacter species are widespread environmental gram-negative coccobacilli that are associated with nosocomial infections; these bacteria are considered to be of relatively low virulence and rarely cause invasive disease. Fifty-two cases of bacteremic episodes due to Acinetobacter species were reviewed, and risk factors and outcomes of these cases were examined. It was noted that these cases belonged to a few clinical groups with markedly different outcomes. Eighteen patients had malignancies (predominantly hematologic), and bacteremia often developed after respiratory infection. Nine patients suffered traumatic injuries and developed bacteremia with Acinetobacter species after endotracheal intubation in the intensive care unit and respiratory colonization. Four burn patients, three of whom had burns covering > or = 50% of their body surface areas, had burn infections prior to bacteremia. While many patients had central venous catheters, in only four cases were the catheters clearly infected prior to the positive blood culture. Prior use of antibiotics was widespread in all groups of patients, and isolates showed high levels of antimicrobial resistance, particularly to beta-lactam agents. The outcome of infection correlated more closely with the type of underlying illness than with other factors such as biovar, polymicrobial bacteremia, or appropriate therapy. Patients with malignancies and burn patients fared poorly (10 of 18 and 2 of 4 patients, respectively, died), while trauma patients and patients with other illnesses did well.
不动杆菌属是广泛存在于环境中的革兰氏阴性球杆菌，与医院感染相关；这些细菌被认为毒力相对较低，很少引起侵袭性疾病。回顾了52例由不动杆菌属引起的菌血症病例，并对这些病例的危险因素和转归进行了研究。注意到这些病例分属于几个临床组，其转归明显不同。18例患者患有恶性肿瘤（主要是血液系统肿瘤），菌血症常发生于呼吸道感染后。9例患者有创伤性损伤，在重症监护病房气管插管和呼吸道定植后发生了不动杆菌属菌血症。4例烧伤患者，其中3例烧伤面积覆盖身体表面积≥50%，在发生菌血症之前有烧伤感染。虽然许多患者有中心静脉导管，但只有4例在血培养阳性之前导管明显被感染。所有患者组中抗生素的先前使用都很普遍，分离株显示出高水平的抗菌耐药性，尤其是对β-内酰胺类药物。感染的转归与基础疾病的类型比与其他因素如生物变种、多微生物菌血症或适当治疗更密切相关。患有恶性肿瘤的患者和烧伤患者预后较差（分别为18例中的10例和4例中的2例死亡），而创伤患者和患有其他疾病的患者情况良好。
