Hematogenous Osteomyelitis by Acinetobacter Baumannii: Case Report and Literature Review
26
antimicrobial agent in the treatment of MDR Acineto-
bacter species. Nephrotoxicity associated with polymy-
xin B was not a concern in our case since the patient was
already receiving hemodialysis. None of the cases of
Acinetobacter osteomyelitis reported in the literature was
treated with polymyxin B. The addition of ampicillin-
sulbactam was beneficial in this case, and dual antim-
icrobial therapy may have contributed to good outcome.
It would be difficult to determine if one factor has made
the difference (surgical interventions, duration of antim-
icrobials, dual therapy) or a combination of all. Nonethe-
less, our patient responded well with this multifaceted
treatment approach.
3. Conclusions
In conclusion, this is the first reported case of MDR A.
baumannii hematogenous osteomyelitis. While in most
documented cases of A. baumannii osteomyelitis, entry
appears to require direct inoculation; our case suggests
that this pathogen can seed into bone hematogenously in
the setting of immunosuppression, persistent bacteremia
and possibly in the presence of underlying bone infarcts.
The ability of Acinetobacter to cause metastatic bone
infections has not been previously reported and further
studies may be warranted. Clinicians need to be aware of
this rare possible consequence of A. baumannii bactere-
mia. In addition, increasing prevalence of this organism
worldwide may warrant the need for newer antimicrobi-
als with activity against these organ isms. Combination of
multiple surgical debridements and dual antimicrobial
therapy for a long period may result in a good outcome.
4. Acknowledgements
First of all, we like to thank our patient for giving us
permission and written consent to collect all the relevant
information. We are very thankful to Dr. Alfonso Ortiz
for his help throughout the project and Dr. Catherine
Maldjian to guide us in selecting appropriate radiological
images for this report. We could not have completed this
case report without the support from all the administra-
tive staff of medical record and radiological departments
of Bronx Lebanon Hospital Center and Montefiore Med-
ical Center.
REFERENCES
[1] H. Wisplinghoff, T. Bischoff, M. T. Sandra, et al., “No-
socomial Bloodstream Infections in US Hospitals: Analy-
sis of 24,179 Cases from Prospective Nationwide Sur-
veillance Study,” Clinical Infectious Diseases, Vol. 39,
No. 3, 2004, pp. 309-317. doi:10.1086/421946
[2] P. E. Fournier, “The Epidemiology and Control of Aci-
netobacter Baumannii in Health Care Facilities,” Clinical
Infectious Diseases, Vol. 42, No. 5, 2006, pp. 692-699.
doi:10.1086/500202
[3] C. Webster, K. Towner and H. Humphreys, “Survival of
Acinetobacter on Three Clinically Related Inanimate
Surfaces,” Infect Control Hosp Epidemiol, Vol. 21, No. 4,
2000, p. 246. doi:10.1086/503214
[4] C. Wendt, B. Dietz, E. Dietz, et al., “Survival of Acine-
tobacter Baumannii on Dry Surfaces,” Journal of Clinical
Microbiology, Vol. 35, No. 6, 1997, pp. 1394-1397.
[5] B. Kurcik-Trajkovska, “Acinetobacter Spp.—A Serious
Enemy Threatening Hospitals Worldwide,” Macedonian
Journal of Medical Sciences, Vol. 2, No. 2, 2009.
[6] J. M. Cisneros and J. Rodriguez-Bano, “Nosocomial
Bacteremia due to Acinetobacter Baumannii: Epide-
miology, Clinical Features, and Treatment,” Clinical Mi-
crobiology and Infection, Vol. 8, No. 7, 2002, pp.
687-693. doi:10.1046/j.1469-0691.2002.00487.x
[7] E. Playford, J. Craig and J. Iredell, “Carbapenem-
Resistant Acinetobacter Baumannii in Intensive Care Unit
Patients: Risk Factors for Acquisition, Infection and Their
Consequences,” The Journal of Hospital Infection, Vol.
65, No. 3, 2007, pp. 204-211. doi:10.1086/503214
[8] P. A. Tiley and F. J. Roberts, “Bacteremia with Acineto-
bacter Species: Risk Factors and Prognosis in Different
Clinical Settings,” Clinical Infectious Diseases, Vol. 18,
No. 6, 1994, pp. 896-900. doi:10.1093/clinids/18.6.896
[9] J. L. Garcia-Garmendia, C. Ortiz-Leyba, J. Garnacho-
Montero, et al., “Risk Factors for Acinetobacter Bauman-
nii Nosocomial Bacteremia in Critically Ill Patients: A
Cohort Study,” Clinical Infectious Diseases, Vol. 33, No.
7, 2001, pp. 933-939. doi:10.1086/322584
[10] M. J. Tong, “Septic Complications of War Wounds,” The
Journal of the American Medical Association, Vol. 305,
No. 24, 1972, pp. 1044-1047.
doi:10.1001/jama.219.8.1044
[11] R. Martin, D. Martin and C. Levy, “Acinetobacter Os-
teomyelitis from a Hamster Bite,” The Pediatric Infec-
tious Disease Journal, Vol. 7, No. 5, 1988, pp. 364-365.
doi:10.1097/00006454-198805000-00020
[12] G. Volpin, N. Krivoy and H. Stein, “Acinetobacter Sp.
Osteomyelitis of the Femur: A Late Sequel of Unrecog-
nized Foreign Body Implantation,” Injury, Vol. 24, No. 5,
1993, pp. 345-346.
doi:10.1016/0020-1383(93)90063-C
[13] J. Schafer and J. Mangino, “Multidrug Resistant Acine-
tobacter Osteomyelitis from Iraq,” Emerging Infectious
Diseases, Vol. 14, No. 3, 2005, pp. 512-514.
doi:10.3201/eid1403.070128
[14] K. Davis, K. Moran, C. McAllister and P. Gray, “Multi-
drug-Resistant Acinetobacter Infections in Soldiers,”
Emerging Infectious Diseases, Vol. 11, No. 8, 2005, pp.
1218-1224.
[15] S. C. Collinet-Adler, C. A. Castro, C. G. Ledonio, et al.,
“Acinetobacter Baumannii Is Not Associated with Os-
teomyelitis in a Rat Model,” Clinical Orthopaedics and
Related Research, Vol. 469, No. 1, 2011, pp. 274-282.
doi:10.1007/s11999-010-1488-0
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