Managing Acinetobacter baumannii infections

Current Opinion in Infectious Diseases - Tập 32 Số 1 - Trang 69-76 - 2019
José Garnacho‐Montero1,2, Sébastien Bailly3,4
1Instituto de Biomedicina. Sevilla (IBIS), Seville, Spain
2Instituto de Biomedicina, Sevilla (IBIS), Seville, Spain; Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena
3IAME U 1137 Paris Diderot University – Inserm, Paris, France
4Medical and infectious diseases ICU (MI2) APHP Bichat University Hospital

Tóm tắt

Purpose of review

We reviewed recent data about epidemiology of Acinetobacter baumannii, resistance mechanisms, and therapeutic options for severe infections caused by multidrug-resistant strains.

Recent findings

A. baumannii is a major cause of nosocomial infections affecting mainly to debilitating patients in the ICU, although the spread to regular wards and to long-term care facilities is increasing. It is characterized by its great persistence in the environment and to have an extraordinary capability to develop resistance to all antimicrobials.

Carbapenems may not be considered the treatment of choice in areas with high rates of carbapenem-resistant A. baumannii. Nowadays, polymyxins are the antimicrobials with the greatest level of in-vitro activity against A. baumannii. Colistin is the most widely used in clinical practice although polymyxin B seems to be associated with less renal toxicity. Colistin is administered intravenously as its inactive prodrug colistimethate. A loading dose of 9 million IU and subsequently high, extended-interval maintenance doses (4.5 million IU/12 h) are recommended. Combination therapy instead of monotherapy increases the rates of microbiological eradication although no clinical study has demonstrated a reduction in clinical outcomes (mortality or length of stay).

Summary

The optimal treatment for multidrug-resistant A. baumannii nosocomial infections has not been established. There are no compelling data to recommend combination therapy for severe A. baumannii infections.

Từ khóa


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