Herellea vaginicola

Medicine (Baltimore). 1977 Mar ;56 (2):79-97 846390 (P,S,G,E,B) Cited:32 [Cited?]Infections with Acinetobacter
calcoaceticus (
Herellea vaginicola): clinical and laboratory studies.

[My paper] R H Glew, R C Moellering, L J Kunz
In a retrospective review of 53 patients, 58 episodes of infection due to Acinetobacter calcoaceticus var. anitratus
(Herellea vaginicola) were studied. Although the organism is widely distributed in nature, it is of relatively low virulence
since colonization is more frequently noted than infection and since most infections occur in patients subjected to the
epidemiologic pressures common to nosocomial, gram-negative bacillary infection: prior antibiotic therapy;
instrumentation and manipulation (e.g., endotracheal intubation, urinary bladder catheterization, arterial and venous
cannulation); surgery; hospitalization, especially with residence in an intensive care unit; severe underlying disease,
either systemic (e.g., chronic obstructive pulmonary disease, malignancy) or localized to the infected area (e.g., prior
bacterial or aspirational pneumonia, trauma). Pneumonia was the most common infection due to A. calcoaceticus, and
occurred only in patients with a tracheostomy or endotracheal tube in place. In over half the 25 patients, more than one
lobe was involved and bronchopneumonia was the usual roentgenographic appearance. Cavitation (2 patients) and
empyema formation (3 patients) were uncommon. The severity of acinetobacter pneumonia is reflected in the high
mortality rate (44% overall, with a 36% mortality rate due primarily to infection). Tracheobronchitis due to A.
calcoaceticus was less severe than pneumonia since no patients died primarily as a result of the infection. Urinary tract
infections occurred in five patients, none of whom were ill and none of whom died. Urinary bladder catheterization was
thought to be responsible for infection in three patients, and in at least four of the five patients infection was restricted
to the lower tract. Wound infections were noted in six patients who had undergone surgery and were related to the
presence of foreign bodies in the operative site in five of the patients. Surgical debridement and/or drainage of the
infected area was the primary therapeutic measure employed in most cases. Only one patient died and this was a
result of noninfectious causes. Skin infection due to A. calcoaceticus was seen in two patients, one of whom exhibited
fulminant, fatal cellulitis and septicemia in the setting of pancytopenia. All nine patients with acinetobacter septicemia
had received antecedent antibiotic therapy, and in all cases intravenous catheters were in place at the time bacteremia
occurred. Clinically, seven of the nine patients were in shock. The mortality rate was 44% overall, with a 22% mortality
rate due to infection. Although septicemia was thought to be "line-related" in five of the nine patients, serious
post-bacteremic complications developed in three patients: prosthetic valve endocarditis, suppurative thrombophlebitis
and subhepatic abscess.
Mesh-terms: Acinetobacter :: drug effects; Acinetobacter Infections :: diagnosis; Acinetobacter Infections :: drug
therapy; Adult; Anti-Bacterial Agents :: pharmacology; Anti-Bacterial Agents :: therapeutic use; Bronchitis :: drug
therapy; Child; Drug Synergism; Female; Human; Male; Microbial Sensitivity Tests; Pneumonia :: diagnosis; Pneumonia
:: drug therapy; Pneumonia :: mortality; Retrospective Studies; Septicemia :: diagnosis; Septicemia :: drug therapy; Skin
Diseases, Infectious :: drug therapy; Surgical Wound Infection :: diagnosis; Surgical Wound Infection :: drug therapy;
Tracheitis :: drug therapy; Urinary Tract Infections :: diagnosis; Urinary Tract Infections :: drug therapy;