Epidemiology and Treatment of Multidrug-Resistant Acinetobacter baumannii

• Published in: Current treatment options in infectious disease 2014, Vol.6 (4), p.409-424
• Main Authors: Álvarez-Marín, Rocío, Molina Gil-Bermejo, José, Cisneros, José M.
• Format: Article
• Language: English
• Subjects: Acinetobacter baumannii; Animal models; Bacteremia; Bacterial Infections and Drug Resistant Pathogens (H Wisplinghoff; Carbapenems; Colistin; Dosage; Drug therapy; Epidemiology; Infectious Diseases; Medicine; Medicine & Public Health; Meningitis; Multidrug resistance; Nosocomial infection; Nosocomial infections; Section Editor; Sulbactam; Tigecycline; Toxicity; Ventilator-associated pneumonia
• ISSN: 1534-6250; 1523-3820; 1534-6250
• DOI: 10.1007/s40506-014-0030-4

Opinion statement Multidrug-resistant Acinetobacter baumannii (MDRAB) is a global threat and a frequent cause of serious nosocomial infections, such as ventilator-associated pneumonia, bacteremia, or meningitis. When available, carbapenems are the first-line treatment, at least for severe infections. Due to its efficacy and narrow spectrum, we consider sulbactam to be the best choice for carbapenem-resistant A. baumannii (CRAB). Unfortunately, susceptibility to sulbactam is unusual among these strains. Colistin should be reserved for treating infections produced by A. baumannii resistant to both carbapenems and sulbactam. In areas of a low rate of susceptibility to these agents, colistin must be considered part of the empirical treatment in patients with severe infections if participation of CRAB is suspected. Tigecycline is a second-line treatment that should be restricted to salvage therapies, especially in cases of off-label infections. The dosages of sulbactam, colistin, and tigecycline are under review. In particular, therapeutic schemes of colistin have incorporated a loading dose and have increased the total daily dose. Optimized dosages could enhance the treatment of MDRAB in the future. Combined therapy produced promising results in vitro and in animal models, but its clinical superiority over efficient monotherapy has not been reliably demonstrated. In this context, combined therapy should not be used, in order to reduce the risk of toxicity and the emergence of resistant strains. New therapies are urgently needed.