Med-Surg: Chapter 21: Acinetobacter Baumannii Flashcards
Acinetobacter: Why is it a Multidrug resistant organism (MDR)
resistant to more than 3 classes of antibiotics
How did MDR Acinetobacter emerge?
the use of broad-spectrum antimicrobials and the transmission of strains among patients
Risk factors for Acinetobacter
- recent surgery
- invasive procedure/medical devices
- tracheostomy
- mechanical ventilation
- enteral feedings
- recent antibiotic use
- prolonged hospitalizations
- ICU admission
- prior hospitalization
- residing in long-term care facility
Pathophysiology of Acinetobacter
nonfermentative, aerobic, gram-negative coccobacillus that naturally inhabit water, soil, animals, and humans
- grows at varying temperatures and pH environments
- recovered from skin, throat, and rectum of humans
- colonizes on respiratory tract
- ability to survive for weeks to months on both dry and moist surfaces
- becomes resistant to antimicrobials: has an impermeable outer membrane, antimicrobial-inactivating enzymes, reduced access to bacterial targets, and mutations that change targets or cellular function
How is A. baumannii spread?
- direct when a it is transferred from patient to patient without a contaminated intermediate object or person; happens when a infected and non-affected patient share a same room
- in-direct when transferred through a contaminated object or person
- most common: hands of healthcare personnel
- occurs through contaminated skin, body fluids, equipment, or the environment
- respiratory equipment, wound care procedures, humidifiers, and patient care items are a source
Clinical Manifestations
can infect or colonize many body sites
- respiratory tract, blood, pleural fluid, peritoneum, urinary tract, surgical wounds, central nervous system (CNS), skin, and eyes
- ventilator-associated pneumonia
- bloodstream infections
Complications
- increase mortality and morbidity
- increased length of hospitalization
- increase length of ventilator days
Medications Given for Acinetobacter
- Ampicillin/Sulbactam (Unasyn)
- Tobramycin (Tobrex)
- Doxycycline (Doxy-100)
Medications for Acinetobacter: Ampicillin/Sulbactam (Unasyn)
- bactericidal
- given IV or IM
- used for mild to severe cases of A. baumannii
- causes diarrhea or rash
- decreases effectiveness of oral contraceptives
Medications for Acinetobacter: Tobramycin
aminoglycoside agent
- given IV
- peak and trough levels obtained every 3 to 4 days to maintain therapeutic dose
Peak level
medication levels obtained 30 minutes after administration
Trough level
blood sample drawn after a dose is given but immediately before the next dose
Medications for Acinetobacter: Doxycycline
tetracycline agent
- given IV or orally
- decrease effectiveness of oral contraceptives
- cause sun sensitivity
- orally: take 1 hour before meals or 2 hours after meals to help with absorption
- fluid hydration to prevent esophageal irritation or ulcer
- can cause GI disturbances
- CBC, liver, and Kidney function tests
Nursing Interventons
- Blood cultures from 2 different sites
- antibiotics
- VS
- hand washing
- hydration
