Acinetobacter baumannii skin and soft-tissue infection associated with war trauma.
BACKGROUND
Acinetobacter baumannii is usually associated with nosocomial pneumonia or bacteremia. Reports of A. baumannii skin and soft-tissue infection (SSTI) are uncommon.


METHODS
We performed a retrospective review of 57 inpatients admitted to a naval hospital ship and identified 8 patients with A. baumannii-associated SSTI. Demographic and clinical characteristics were compared between these patients and 49 patients with A. baumannii infections that were not SSTIs. We also reviewed 18 cases of A. baumannii-associated SSTI from the literature.


RESULTS
Our 8 cases of A. baumannii-associated SSTI were associated with combat trauma wounds. The median age of the patients was 26 years. Although not statistically significant, A. baumannii-associated SSTIs were more likely to be associated with gunshot wounds (75% vs. 55%) or external fixators (63% vs. 29%), compared with A. baumannii infections that were not SSTIs. Use of a central venous catheter and total parenteral nutrition was also more common for patients with SSTI. Our cases of A. baumannii-associated SSTI presented as cellulitis with a "peau d'orange" appearance with overlying vesicles and, when untreated, progressed to necrotizing infection with bullae (hemorrhagic and nonhemorrhagic). In our case series, all isolates were multidrug resistant, and clinical success was achieved for 7 of 8 patients with debridement and carbapenem therapy.


CONCLUSIONS
A. baumannii-associated SSTI is an emerging infection in patients who experience trauma. Clinicians should be aware of the potential role of A. baumannii as a multidrug-resistant pathogen causing hospital-acquired SSTI, particularly when associated with previous trauma or use of invasive devices. It should be suspected in patients who experience trauma and have edematous cellulitis with overlying vesicles. Early empirical coverage for drug-resistant species (e.g., with carbapenem therapy), combined with debridement, is usually curative.
Sebeny
Peter J
PJ
National Naval Medical Center, Bethesda, Maryland, USA.
Riddle
Mark S
MS
Petersen
Kyle
K
D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D003646:Debridement; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008889:Military Personnel; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D014948:Wounds, Gunshot / Q000150:complications / Q000382:microbiology / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D015780:Carbapenems