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Similarly, the recently published genome sequence of A. Baumannii ATCC demonstrated a wide array of resistance markers but only one within the homologous location to that described by Fournier et al. , again illustrating the genetic flexibility of this pathogen. In vitro, colistin demonstrates concentration-dependent bactericidal activity against A.

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This identification scheme was refined in 1987 by the same authors and includes growth at 37°C, 41°C, and 44°C; production of acid from glucose; gelatin hydrolysis; and assimilation of 14 different carbon sources . In particular, the closely related and clinically most relevant species A. Baumannii and Acinetobacter genomic species 13TU cannot be distinguished, while A. Calcoaceticus and Acinetobacter genomic species 3 can only be separated by their growth properties at different temperatures . Given the current therapeutic environment, optimizing the use of existing antimicrobials is critical. The following section concentrates on the available in vitro, animal, and human data to assist the reader in the management of infections due to highly drug-resistant A.

However, the literature is expanding outside this patient population (Table ​ . It now appears that the image of A. Baumannii as a low-virulence pathogen is under extreme scrutiny. Community-acquired pneumonia due to A. Baumannii has been described for tropical regions of Australia and Asia .

Resistance to tetracyclines and their derivatives can be mediated by efflux or ribosomal protection . Tetracycline-specific efflux pumps include those encoded by the tet to tet determinants, most often found within gram-negative organisms, and the tet determinant found in Staphylococcus aureus. Thus far, the tet and tet determinants have been described for A. Tet was found within a transposon similar to Tn1721, in association with an IS element . Tet confers resistance to tetracycline but not minocycline, an agent with greater activity against A.

Sulbactam is one of three commercially available β-lactamase inhibitors. Unlike clavulanic acid and tazobactam, it has clinically relevant intrinsic antimicrobial activity against certain organisms, specifically Acinetobacter and Bacteroides spp. Sulbactam is commercially available in a combined formulation with either ampicillin or cefoperazone and also as a single agent in France, Germany, and Spain .

Inactivation of the blaOXA-40 gene led to susceptibility to carbapenems, and resistance was restored with complementation. This discrepancy is most likely due to the presence of IS elements in the natural plasmids. Most Acinetobacter species that have been recovered from human clinical specimens have at least some significance as human pathogens . Acinetobacters are part of the human skin flora. In an epidemiological survey performed to investigate the colonization of human skin and mucous membranes with Acinetobacter species, up to 43% of nonhospitalized individuals were found to be colonized with these organisms . The most frequently isolated species were A.

In the absence of human or animal model data, it is impossible to determine which testing method is more clinically relevant. Finally, interlaboratory variations in susceptibility testing results were frequent, especially for cefepime . In contrast to the findings with these β-lactams, there was little MIC and zone diameter discrepancy for carbapenems, aminoglycosides, fluoroquinolones, and trimethoprim-sulfamethoxazole .