不动杆菌的感染（来自08年新英格兰医学杂志的综述）

David

学过医的战友都知道此杂志在医学中的地位，特别是刊登的综述，那就是牛牛牛:cool :cool :cool
N Engl J Med. 2008 Mar 20;358(12):1271-81. Links
Acinetobacter infection.
不动杆菌的感染
Munoz-Price LS, Weinstein RA.
Medical Specialists, Dyer, IN 46311, USA. simunozprice@gmail.com

Acinetobacter is a gram-negative coccobacillus (fig. 1)1,2 that during the past three decades has emerged from an organism of questionable
pathogenicity to an infectious agent of importance to hospitals worldwide.3,4 Approximately one quarter of the PubMed citations for “nosocomial acinetobacter”
in the past 20 years appeared in 2005 and 2006. Acinetobacter infections have long been clinically prominent in tropical countries, have been a recurrent problem during wars and natural disasters, and have recently caused multihospital outbreaks in temperate climates. Most alarming are the organism’s ability to accumulate diverse mechanisms of resistance, the emergence of strains that are resistant to all commercially available antibiotics,5 and the lack of new antimicrobial agents in development.6 At more than 300 U.S. hospitals surveyed by the Centers for Disease Control and Prevention (CDC), rates of carbapenem resistance in 3601 isolates of Acinetobacter baumannii, clinically the most important of 25 acinetobacter genospecies,1 increased from 9% in 1995 to 40% in 2004.7

Acinetobacter was first described in 1911 as Micrococcus calco-aceticus.8 Since then, it has had several names, becoming known as acinetobacter in the 1950s.1,2 Its natural habitats are water and soil, and it has been isolated from foods, arthropods, and the environment.3 In humans, acinetobacter can colonize skin, wounds, and the respiratory and gastrointestinal tracts. Some strains of acinetobacter can survive environmental desiccation for weeks, a characteristic that promotes transmission through fomite contamination in hospitals.1,9

Acinetobacter is easily isolated in standard cultures but is relatively nonreactive in many biochemical tests commonly used to differentiate among gram-negative bacilli. This can delay isolate identification by a day. A. baumannii, A. calcoaceticus, and A. lwoffii are the acinetobacter species most frequently reported in the clinical literature. Because it is difficult to differentiate among acinetobacter species on the basis of phenotypic characteristics, the term A. calcoaceticus–A. baumannii complex is sometimes used.1

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