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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 4  |  Page : 573
Prosthetic valve endocarditis caused by Acinetobacter baumannii complex


1 Department of Microbiology, DR. ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, Tamil Nadu, India
2 Department of Cardiology, Madras Medical College and General Hospital, # 4/4 F Type, Chennai 600 001, Tamil Nadu, India

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How to cite this article:
Kumar S S, Vengadassalapathy L, Menon T. Prosthetic valve endocarditis caused by Acinetobacter baumannii complex. Indian J Pathol Microbiol 2008;51:573

How to cite this URL:
Kumar S S, Vengadassalapathy L, Menon T. Prosthetic valve endocarditis caused by Acinetobacter baumannii complex. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Feb 27];51:573. Available from: http://www.ijpmonline.org/text.asp?2008/51/4/573/43773


Sir,

The Acinetobacter
species are encapsulated gram-negative, coccobacilli that reside as a normal flora of the skin, oropharynx, and perineum. They are usually considered to be opportunistic pathogens and often cause a variety of nosocomial infections. [1] We report a case of endocarditis caused by Acinetobacter baumannii complex in a patient who had undergone a surgical replacement of the mitral valve.

A 23-year-old female was admitted to the Department of Cardiology, Government General Hospital, Chennai in January 2008 with complaints of fever for 4 months duration, palpitations, and chest pain. Her medical history revealed that she had undergone a surgical replacement of the mitral valve with a Starr Edward prosthetic valve in 2003. On physical examination, her blood pressure was 90/70 mmHg, her pulse rate was 90 per min, and her body temperature was >38ºC. Her random blood sugar was 96 mg/dl, blood urea was 18 mg/dl, and serum creatinine was 0.6 mg/dl. The transthoracic echocardiogram demonstrated vegetation on the prosthetic mitral valve with mild aortic regurgitation.

Blood cultures were done by collecting three consecutive blood samples at hourly intervals in Brain Heart infusion broth supplemented with 0.04% sodium polyanethol sulphonate (HIMEDIA Laboratories, Mumbai). Turbidity was noticed in all three bottles within 18-24 hours and gram-stained smears showed gram-negative pleomorphic coccobacilli, which grew as non lactose fermenting colonies on MacConkey agar and smooth non hemolytic colonies on blood agar. The organism was oxidase negative, catalase positive, and non motile. The isolate was identified as Acinetobacter baumanii complex (Acb) based on glucose oxidation and susceptibility to penicillin and chloramphenicol. [2] Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standard Institute recommendations. [3] The isolate was found to be sensitive to a majority of the antibiotics tested but resistant to penicillin, ampicillin, clindamycin, and linezolid. The patient was treated with ofloxacin (200 mg by IV twice daily) and amikacin (250 mg by IV twice daily) and was soon afebrile. Subsequently, she was discharged from the hospital and advised to continue ofloxacin 200 mg twice daily for a period of 1 month.

Lahiri, et al. [2] have reported an overall 75.6% of Acinetobacter baumanni complex among the Acinetobacter isolates and 69.7% were found to be multidrug resistant. Acinetobacter spp spreads easily in the environment of colonized patients and persists in the environment for several days even on dry surfaces, such as, equipment, telephone handles, doors, patient charts, tabletops, etc. [4] In the case of this patient, the infection was most likely to have been post-partum. We had previously reported a multidrug resistant Acinetobacter baumannii complex from a patient in the same hospital and found sensitivity only to imipenem. [5] In contrast, the present isolate was sensitive to most of the antibiotics and the patient recovered. Acinetobacter baumannii though initially thought to be an organism of questionable pathogenicity has now emerged as an important etiological agent of nosocomial infections, and the high potential of this organism to develop antibiotic resistance is responsible for its ability to cause life-threatening infections in susceptible patients.

 
   References Top

1.Towner KJ. Clinical importance and antibiotic resistance of Acinetobacter spp. J Med Microbiol 1997;46:721-46.  Back to cited text no. 1  [PUBMED]  
2.Lahiri KK, Mani NS, Purai SS. Acinetobacter spp as nosocomial pathogen: Clinical significance and antimicrobial sensitivity. MJAFI 2004;60:7-10.  Back to cited text no. 2    
3.Performance Standards for antimicrobial susceptibility testing. Clinical and Laboratory Standards Institute (CLSI) M100-S17 2007;27:106-7.  Back to cited text no. 3    
4.Bergogne-Bιrιzin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: Microbiological Clinical and Epidemiological Features. Clin Microbiol Rev 1996;9:148-65.   Back to cited text no. 4    
5.Menon T, Shanmugasundaram S, Nandhakumar B, Nalina K, Balasubramaniam. Infective endocarditis due to Acinetobacter baumannii complex: A case report. Indian J Pathol Microbiol 2006;49:576-8.  Back to cited text no. 5  [PUBMED]  

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Correspondence Address:
Thangam Menon
Department of Microbiology, DR. ALM PG Institute of Basic Medical Sciences, Taramani, Chennai 600 113
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.43773

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