Acinetobacter baumannii-associated skin and soft tissue infections: recognizing a broadening spectrum of disease.
BACKGROUND
Acinetobacter baumannii is gaining importance as a cause of nosocomial infections, but its role in skin and soft tissue infection (SSTI) is not well defined. As a result of the outbreak of A. baumannii occurring in military personnel in Iraq and Afghanistan, reports of severe wound infections and SSTI caused by this pathogen are increasing in frequency.


METHODS
We describe four cases of monomicrobial and polymicrobial A. baumannii-associated necrotizing SSTI accompanied by A. baumannii bacteremia and offer a review of similar experiences published in the literature.


RESULTS
Our comparative analysis reveals four unique features associated with necrotizing SSTI associated with A. baumannii: i) Occurs in hosts with underlying comorbidities (e.g., trauma, cirrhosis); ii) is often accompanied by bacteremia; iii) multiple drug resistance and the presence of co-pathogens frequently complicated treatment (64% of cases); iv) the cases reported here and in our review required surgical debridement (84% of cases) and led to substantial mortality (approximately 30%).


CONCLUSIONS
As the prevalence of A. baumannii continues to increase in our health care system, SSTIs caused by this organism may become more common. Clinicians must be aware that the spectrum of disease caused by A. baumannii could include severe necrotizing SSTI and that vigilance for potential complications is necessary.
Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Dubert M
DM
Guerrero
Federico
F
Perez
Nicholas G
NG
Conger
Joseph S
JS
Solomkin
Mark D
MD
Adams
Philip N
PN
Rather
Robert A
RA
Bonomo
D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D000368:Aged; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008297:Male; D008875:Middle Aged; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D055815:Young Adult