By exhibiting resistance to most known antibiotics or quickly acquiring resistance to antimicrobials it was once susceptible to, Acinetobacter baumannii has attracted increasing attention worldwide since the last decades of the previous century. The resistance abilities of the bacterium were soon shown to be so advanced that it was even able to resist antibiotics that had only just been discovered and used for first time. Utilizing complex mechanisms of resistance, combining different modalities, and achieving new resistant traits established A. baumannii as one of the most clinically important and challenging pathogens of the new century, being categorized by the World Health Organization as a critical priority bacterium for which new antibiotics are urgently needed. After even last-resort, broad-spectrum antibiotics were rendered useless, the fight against this superbug began to be led by the reintroduction of once abandoned antimicrobials, new combination therapies and novel modalities of treatment. In this chapter, we will look at the history and background of Acinetobacter species and then specifically focus on A. baumannii, explaining its clinical importance in detail, reviewing the most recent findings regarding its mechanisms of resistance, latest modalities of treatment and newest areas of research towards opening new frontiers in the management of infections caused by multi-resistant strains of this bacterium.
A. baumannii imposes a great burden on medical systems worldwide. Surveillance of trends of antibiotic resistance provides a great deal of information needed for antimicrobial stewardship programmes nationwide. Clinical data from long-term, continuous surveillance on trends of antibiotic resistance of A. baumannii in Slovakia is missing. One hundred and forty-nine samples of A. baumannii were isolated over a period of four years. A panel of 19 antibiotics from seven antibiotic categories were tested for the bacterium’s susceptibility. Resistance results were evaluated, and the significance of patterns was estimated using simple linear regression analysis. All isolates were more than 85% resistant to at least 13 out of the 19 tested antibiotics. A significant rise in resistance was recorded for aminoglycosides and imipenem from 2019 to 2022. Colistin and ampicillin-sulbactam have been the only antibiotics maintaining more than 80% efficacy on the bacterium to date. A significant rise in extensively drug-resistant (XDR) strains among carbapenem-resistant (CR) isolates has been recorded. Multidrug-resistance (MDR) among all A. baumannii isolates and XDR among CR strains of the bacterium have risen significantly in the last four years.
Background: The COVID-19 pandemic in 2020 exerted immense pressure on health care systems worldwide, causing substantial resources to be diverted to respond to the pandemic. These changes raise the concern about the potential for reduction in adherence to long-established measures in the prevention of healthcare-associated infections (HAI). Enterococcus species account for most of human enterococcal HAI and multidrug-resistant infections and have become a major threat to modern public health. We examine the rise in the number of vancomycin resistant E. faecium blood stream and urinary tract infections in a COVID-19 department during an epidemiologic outbreak investigation to detect and eliminate nosocomial clusters of the bacteria. Methods: Strain identification was performed by classical isolation and biochemical and cultivation methods. Antibiotic testing results were interpreted according to European committee on antimicrobial susceptibility testing (EUCAST) guidelines. Six isolated samples underwent whole genome sequencing (WGS) during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing.Results: WGS revealed two genotypically distinct VRE clusters, one of which had genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control strategies.Conclusions: This study provides the first description of an outbreak caused by vanA-ST17 E. faecium strains among COVID-19 patients in central Europe, and the first description of an outbreak caused by vanB-ST117 and vanA-ST17 E. faecium strains in Slovakia. This study can help raise awareness about the need for strict adherence to infection control measures and the implementation of rational antimicrobial stewardship as a routine part of COVID-19 management.
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