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Semin Respir Crit Care Med 2017; 38(03): 311-325
DOI: 10.1055/s-0037-1599225
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infections Due to Acinetobacter baumannii in the ICU: Treatment Options

Joseph P. Lynch III
1   Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
,
George G. Zhanel
2   Department of Medical Microbiology/Infectious Diseases, University of Manitoba, Rady College of Medicine, Winnipeg, Manitoba, Canada
,
Nina M. Clark
3   Division of Infectious Diseases, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
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Publikationsdatum:
04. Juni 2017 (online)

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Abstract

Bacteria within the genus Acinetobacter (principally A. baumannii-calcoaceticus 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 Acinetobacter infections is difficult, as Acinetobacter spp. are intrinsically resistant to multiple antimicrobial agents, and have a remarkable ability to acquire new resistance determinants 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)-A. baumannii 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.

Keywords

multidrug resistance - antimicrobial resistance - Acinetobacter spp. - Acinetobacter baumannii - plasmids - clonal spread - carbapenemases