Multidrug-Resistant<i>Acinetobacter</i>Extremity Infections in Soldiers

Davis, Kepler A.; Moran, Kimberly; McAllister, C. Kenneth; Gray, Paula J.

doi:10.3201/1108.050103

Cited by 282 publications

(212 citation statements)

References 21 publications

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“…Two of 30 femurs (6.7%) in Experiment 2 showed radiographic evidence of bone formation. This occurred in two of five femurs infected with 10 4 CFUs SA and 10 8 CFUs MDR AB at 3 weeks. (10 3 ) 7.7 ± 0.…”

Section: Resultsmentioning

confidence: 93%

“…The literature supports a limited role for A. baumannii in clinical osteomyelitis [8,17,20,21]. In one study, clinical improvement of osteomyelitis, including MDR AB, occurred without recurrence in 18 of 18 patients after a mean of 9 months, often despite the presence of internal stabilization and lack of extended continuation therapy with oral antibiotics.…”

Section: Discussionmentioning

confidence: 97%

“…In one study, clinical improvement of osteomyelitis, including MDR AB, occurred without recurrence in 18 of 18 patients after a mean of 9 months, often despite the presence of internal stabilization and lack of extended continuation therapy with oral antibiotics. These findings were attributed to expert débridement, 6 weeks of directed antibiotics, and to the general good health of the patients [8]. Another study revealed Gram-negative rods like A. baumannii were widely present in first episodes of osteomyelitis but more rarely present in recurrences or treatment failures despite drug resistance and orthopaedic devices [21].…”

Section: Discussionmentioning

confidence: 99%

“…War wounds encountered in soldiers deployed to Iraq and Afghanistan have underscored the need for improved therapy of infected segmental bone defects [1,8,15]. Infection of segmental bone defects is problematic because it usually inhibits bone healing and increases bone resorption [13,16].…”

Section: Introductionmentioning

confidence: 99%

“…However, several studies suggest infections with this organism may be easier to control in combat-related osteomyelitis [8,17,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Collinet-Adler¹,

Castro²,

Ledonio³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Multidrug resistant Acinetobacter baumannii (MDR AB) with and without Staphylococcus aureus (SA) is a commonly isolated organism in infected segmental bone defects in combat-related trauma in Iraq and Afghanistan. Although MDR AB in visceral infections is a therapeutic challenge, control of infection appears more common for combat-related osteomyelitis.Questions/purposes Using a rat model, we explored the virulence of MDR AB in segmental bone defects alone and in combination with SA. Methods Segmental defects in 60 rat femurs were created, stabilized, and inoculated with MDR AB alone and 60 with MDR AB and SA. We performed qualitative and quantitative bacteriology and radiographic assessments at 2, 4, and 8 weeks for MDR AB and at 1, 2, and 3 weeks for MDR AB and SA. Results Quantitative bacteriology revealed a 3-to 5-log decrease in MDR AB from the initial inoculum. After polymicrobial inoculation, only 10 of 60 animals had positive cultures for MDR AB, whereas 59 of 60 animals had positive cultures for SA. Recovered SA were 2 to 5 log greater than the initial inoculum, while there again was a 3-to 5-log decrease in MDR AB. MDR AB alone did not cause bony lysis, but there was radiographic evidence of new bone formation in 67% of the segmental defects. Osteolysis was noted with MDR AB and SA. Conclusions MDR AB did not appear to cause or contribute to clinically apparent osteomyelitis in this pilot study. Clinical Relevance Resolution of infections in combatrelated segmental bone defects inoculated with MDR AB may be attributable to low virulence.

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Section: Resultsmentioning

confidence: 93%