Control of multi-drug resistant acinetobacter infections

Abstract

Although initially considered to be of low virulence, Acinetobacter is being increasingly implicated in severe infections, particularly among hospitalized patients. Infection with Acinetobacter baumannii is associated with increased mortality. Multi-drug resistant strains have emerged worldwide and prior antibiotic use has been identified as a significant risk factor for resistance. Carbapenems are the mainstay of treatment for severe infections. However, carbapenem-resistant strains are emerging. Tigecycline may not be consistently active against those resistant isolates. A considerable proportion of multi-drug resistant A. baumannii strains are only susceptible to polymyxins. Combination treatment has been used, but there is no clear evidence of its superiority over monotherapy. Antimicrobial stewardship programs are necessary to prevent emergence of resistance. Certain factors, such as patient population characteristics specific to a hospital, may play an important role in the effectiveness of antimicrobial stewardship. An important strategy to minimize redundant exposure to antimicrobials is to de-escalate from broader to more targeted therapy, once susceptibility testing results are available. Besides antimicrobial stewardship, any attempt to control the spread of resistant Acinetobacter should include intensive infection control measures.