CHAPTER 21: Acinetobacter, Stenotrophomonas,

and Similar Organisms

all oxidase-negative and grow on MacConkey agar
except for CDC group NO-1
either oxidize or do not utilize glucose
Although NO-1 is oxidase-negative and does not
usually grow on MacConkey agar, it is included here
because it must be distinguished from the
asaccharolytic Acinetobacterspp.

EPIDEMIOLOGY

inhabit environmental niches
Acinetobacter spp. and S. maltophilia being
widely distributed in nature and hospital
environments.
relatively high prevalence of Acinetobacter spp.
and S. maltophilia in hospitals frequently results
in colonization of the skin and respiratory
tract of patients

PATHOGENESIS AND SPECTRUM OF DISEASE

(**all organisms that will be discussed are opportunistic
pathogens for which no definitive virulence factors are
known.)

Acinetobacterspp. and S. maltophilia: relatively common
colonizers of hospitalized patients
clinical significance when found in patient specimens
can be difficult to establish
organisms are more frequently isolated as colonizers
than as infecting agents
**infection does occur, it usually involves debilitated
patients, such as those in burn or intensive care units,
who have undergone medical instrumentation and/or
have received multiple antimicrobial agents.
Infections caused by Acinetobacterspp. and S.
maltophilia usually involve the respiratory or
genitourinary tract, bacteremia, and, occasionally,
wound infections, but infections involving several
other body sites have been described
Community-acquired infections with these
organisms can occur, but the vast majority of
infections are nosocomial.

LABORATORY DIAGNOSIS

SPECIMEN COLLECTION AND TRANSPORT
(**No special considerations are required for
specimen collection and transport of the organisms
discussed in this chapter)


DIRECT DETECTION METHODS

(**no specific procedures for the direct detection of these
organisms in clinical material.)

Acinetobacter spp. are plump coccobacilli that
tend to resist alcohol decolorization; they may be
mistaken for Neisseria spp.
Bordetella spp. are coccobacilli or short rods
S. maltophilia, P. oryzihabitans, and P. luteolaare
short to medium size straight rods.
CDC group NO-1 are coccoid to medium-size bacilli.

CULTIVATION
Media of Choice

Also grow in 5% sheep blood and chocolate agars.
also grow well in the broth of blood culture systems
and in common nutrient broths such as
thioglycollate and brain-heart infusion.

Incubation Conditions and Duration
These organisms generally produce detectable
growth on 5% sheep blood and chocolate agars
when incubated at 35 C in carbon dioxide or
ambient air for a minimum of 24 hours.
MacConkey agar should be incubated only in
ambient air.

COLONIAL APPEARANCE


APPROACH TO IDENTIFICATION

Acinetobacter spp. and S. maltophilia- reliably identified
by the API 20E system (bioMrieux Inc., St. Louis, Mo)
**most reliably identified using conventional biochemical and
physiologic characteristics



Comments Regarding Specific Organisms
There are 25 geno species or genomo species in the
genus Acinetobacter
Each genospecies comprises a distinct DNA
hybridization group and is given a numeric
designation, which has replaced previous species
names.
genus is also divided into two groups:
contains the saccharolytic (glucose-oxidizing) species
contains the asaccharolytic (nonglucose-utilizing)
species
Most glucose-oxidizing, nonhemolytic
strains werepreviously identified as A.
baumanii
Most nonglucose-utilizing, nonhemolytic
strains were designated as A. lwoffi.
The majority of beta-hemolytic organisms were
previously called A. haemolyticus
Nitrate-reducing strains of asaccharolytic
Acinetobacter spp. are difficult to differentiate from
CDC group NO-1 **Acinetobacter transformation
test provides the most dependable criterion for this
purpose, but this test is not commonly performed in
clinical microbiology laboratories.
S. maltophilia
- can produce biochemical profiles similar to those of
Burkholderia cepacia, but a negative oxidase test
most often rules out the latter
- oxidizes maltose faster than glucose (hence the
species name, maltophilia, (maltose loving)
- produces a brown pigment on heart infusion agar
that contains tyrosine.

ANTIMICROBIAL SUSCEPTIBILITY TESTING AND
THERAPY:
Acinetobacter spp. and S. maltophilia- exhibit
resistance to a wide array of antimicrobial agents,
making the selection of agents for optimal therapy
difficult
S. maltophilia- primary drug of choice:
trimethoprim-sulfamethoxazole








PREVENTION:

**organisms are ubiquitous in nature- there are no
recommended vaccination or prophylaxis protocols.
Hospital-acquired infections are best controlled by
following appropriate sterile techniques and
infection control guidelines and by implementing
effective protocols for the sterilization and
decontamination of medical supplies.