Considerations in Control and Treatment of Nosocomial Infections Due to Multidrug‐ResistantAcinetobacter baumannii

Abstract

We sought to control infection due to multidrug-resistant Acinetobacter baumannii (MDR-Ab) by identifying isolates as clonally related, leading to enhanced infection-control measures, including cohorting, surveillance, contact precaution, initial therapy with ampicillin/sulbactam and local polymyxin B, and, more recently, therapy with synergistic antibiotic combinations. Class restriction of cephalosporins has been associated with a reduction in cephalosporins-cephamycin-carbapenem resistance among nosocomial Klebsiella isolates. This has been supplemented by restriction of carbapenem use after an initial 24-h period in an effort to reduce the selection of porin-deficient, carbapenem-resistant A. baumannii and Pseudomonas aeruginosa. Evidence is reviewed suggesting that eradication of MDR-Ab nosocomial colonization may prevent subsequent infection. Relatively few standard antibacterial drugs remain active against MDR-Ab. Published clinical results of therapy with these agents are reviewed, and in vitro evidence of synergy between them is presented that suggests that combination therapy should be studied for enhanced clinical activity.

Increasing Occurrence of Multidrug-Resistance in Acinetobacter baumannii Isolates From Four German University Hospitals, 2002–2006

“…The identification of a common source should be prompted and include targeted screening of potentially colonised or infected contact persons, such as health care workers, and sampling of the hospital environment, particularly in ICUs [13]. Considerations in the control and treatment of nosocomial infections due to multidrug-resistant A. baumannii isolates were published by Urban et al [14], such as the daily review of antibiotic susceptibility of all clinical isolates.…”

Multidrug-ResistantAcinetobacterExtremity Infections in Soldiers

“…The difficulty in treating these infections is not due to any excessive virulence of the organism per se but rather to its antimicrobial drug resistance. Many nosocomial isolates are resistant to ≥3 classes of antimicrobial agents, which classifies them as MDR organisms (8,12). A common susceptibility pattern in this case series was resistance to all antimicrobial agents except imipenem and amikacin.…”

“…The Acinetobacter isolate was defined as MDR if it was resistant to ≥3 classes of antimicrobial agents as tested by automated antimicrobial drug–susceptibility testing (Vitek, bioMérieux, Hazelwood, MO, USA) (8). On occasion, isolates were further evaluated with disk diffusion antimicrobial testing for susceptibilities to alternate antimicrobial drugs, such as colistin, or to confirm automated susceptibility results.…”

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

“…Infections involving MDR AB, such as pneumonia, meningitis, urinary tract infections, wound infections, and bacteremia can be difficult to treat with few consistently effective antimicrobials [2,19] and often are associated with high mortality, high rates of mechanical ventilation, and the need for considerable assistance in activities of daily living after discharge [1]. However, several studies suggest infections with this organism may be easier to control in combat-related osteomyelitis [8,17,20,21].…”