Infections Due to Acinetobacter baumannii in the ICU: Treatment Options

Abstract

Bacteria within the genus (principally- complex [ABC]) are gram-negative coccobacilli that may cause nosocomial infections in critically ill or debilitated patients (particularly ventilator-associated pneumonia and infections of the bloodstream, urinary tract, and wounds). Treatment of infections is difficult, as spp. are resistant to multiple antimicrobial agents, and have a remarkable ability to via mechanisms that include plasmids, transposons, integrons, and resistance islands. Since the 1990s, global resistance to antimicrobials has escalated dramatically among ABC. Global spread of multidrug-resistant (MDR)- strains reflects dissemination of a few clones between hospitals, geographic regions, and continents; excessive use of antibiotics amplifies this spread. Many isolates are resistant to all antimicrobials except colistin (polymyxin E) and tigecycline, and some infections are untreatable with existing antimicrobial agents. Antimicrobial resistance poses a serious threat to treat or prevent infections due to ABC. Strategies to curtail environmental colonization with MDR-ABD will require aggressive infection control efforts and cohorting of infected patients. Thoughtful antibiotic strategies are essential to limit the spread of MDR-ABC. Optimal therapy will likely require combination antimicrobial therapy of existing antibiotics as well as development of novel antibiotic classes.

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

“…Infections due to Acinetobacter spp., particularly VAP in the ICUs, are mostly seen in critically ill or debilitated patients [17]. After 1 month of follow-up, half of the cases with VAP due to Acinetobacter spp.…”

Pharmacokinetics and Tolerability of Intravenous Sulbactam-Durlobactam with Imipenem-Cilastatin in Hospitalized Adults with Complicated Urinary Tract Infections, Including Acute Pyelonephritis

“…two-thirds of ABC infections are caused by multidrug-resistant (MDR) isolates (6)(7)(8). Serious infections caused by MDR ABC isolates are associated with high rates of morbidity (4,(9)(10)(11)(12), and the rate of mortality may range up to 50% or higher (4,(13)(14)(15).…”

“…Serious infections caused by MDR ABC isolates are associated with high rates of morbidity (4,(9)(10)(11)(12), and the rate of mortality may range up to 50% or higher (4,(13)(14)(15). Thus, an urgent need exists to identify new antimicrobial agents to treat serious ABC infections (8,16).…”

Molecular Epidemiology of Acinetobacter calcoaceticus-Acinetobacter baumannii Complex Isolated From Children at the Hospital Infantil de México Federico Gómez

“…The ward with the highest recurrence of A. baumannii was the ICU, which corresponded to the data from other regions such as Europe, Asia, the United States, Latin America, and Morocco ( Martins et al, 2009 ; Vincent et al, 2009 ; Uwingabiye et al, 2017 ). The high recurrence of isolating A. baumannii in the ICU has been attributed to risk factors for the development of infections, including invasive procedures, catheter placement, and intubation endotracheal, which may cause urinary tract and respiratory tract infections ( Cisneros et al, 1996 ; Lynch et al, 2017 ). However, the development of A. baumannii infections is also related to the immune systems of patients since it has been observed in individuals with serious diseases such as hematological malignancies and diabetes mellitus, and even those subjected to prolonged antimicrobial therapy with broad-spectrum antibiotics ( Vincent et al, 2009 ; Kempf and Rolain, 2012 ; Lin et al, 2016 ).…”