SUMMARY: Acinetobacter baumannii has emerged as a highly troublesome pathogen for many institutions globally. As a consequence of its immense ability to acquire or upregulate antibiotic drug resistance determinants, it has justifiably been propelled to the forefront of scientific attention. Apart from its predilection for the seriously ill within intensive care units, A. baumannii has more recently caused a range of infectious syndromes in military personnel injured in the Iraq and Afghanistan conflicts. This review details the significant advances that have been made in our understanding of this remarkable organism over the last 10 years, including current taxonomy and species identification, issues with susceptibility testing, mechanisms of antibiotic resistance, global epidemiology, clinical impact of infection, host-pathogen interactions, and infection control and therapeutic considerations.

Hospital-acquired infections are most commonly associated with mechanical ventilation, invasive medical devices, or surgical procedures. Gram-negative bacteria are responsible for more than 30% of hospital-acquired infections and predominate in hospital-acquired pneumonia. They are highly efficient at up-regulating or acquiring mechanisms of antibiotic drug resistance, especially in the presence of antibiotic selection pressure. This review updates what clinicians should know about these often life-threatening infections.

Specific defects in innate and adaptive immune function have been identified in diabetic patients in a range ofin vitrostudies. However, the relevance of these findings to the integrated response to infectionin vivoremains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hypo‐responsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community‐acquired infections is less well established but could be clarified if infection data from large community‐based observational or intervention studies were available. The relationship between hospital‐acquired infections and diabetes is well recognized, particularly among post‐operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community‐ and hospital‐acquired infections. Copyright © 2006 John Wiley & Sons, Ltd.

Background.Risk factors for Nocardia infection in organ transplant recipients have not been formally assessed in the current era of transplantation.M