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Acinetobacter infection: Treatment and prevention

INTRODUCTION

Acinetobacter is a gram-negative coccobacillus that has emerged from an organism of questionable pathogenicity to an infectious agent of importance to hospitals worldwide [1]. The organism has the ability to accumulate diverse mechanisms of resistance, leading to the emergence of strains that are resistant to all commercially available antibiotics [2].

The treatment and prevention of Acinetobacter infection will be reviewed here. The clinical features, epidemiology, microbiology, and pathogenesis of Acinetobacter infection are discussed separately. (See "Acinetobacter infection: Epidemiology, microbiology, pathogenesis, clinical features, and diagnosis".)

ANTIMICROBIAL RESISTANCE

Acinetobacter has the ability to develop resistance through several diverse mechanisms, which has led to emergence of strains that are resistant to all commercially available antibiotics [2].

Definitions — In 2011, a joint initiative by the European and United States Centers for Disease Control and Prevention (ECDC and CDC) proposed specific definitions for characterizing drug resistance in organisms that cause many healthcare-associated infections [3]. For Acinetobacter, the following definitions were established based on the extent of resistance to antibiotics that would otherwise serve as treatments for Acinetobacter (ie, cephalosporins, fluoroquinolones, and carbapenems):

Multidrug-resistant: isolate is non-susceptible to at least one agent in three or more antibiotic classes

                          

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Literature review current through: Sep 2014. | This topic last updated: Sep 15, 2014.
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References
Top
  1. Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006; 42:692.
  2. Lolans K, Rice TW, Munoz-Price LS, Quinn JP. Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40. Antimicrob Agents Chemother 2006; 50:2941.
  3. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18:268.
  4. Gaynes R, Edwards JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005; 41:848.
  5. Rhomberg PR, Jones RN. Contemporary activity of meropenem and comparator broad-spectrum agents: MYSTIC program report from the United States component (2005). Diagn Microbiol Infect Dis 2007; 57:207.
  6. Tatman-Otkun M, Gürcan S, Ozer B, Shokrylanbaran N. Annual trends in antibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations. New Microbiol 2004; 27:21.
  7. Sunenshine RH, Wright MO, Maragakis LL, et al. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 2007; 13:97.
  8. Rhomberg PR, Jones RN. Summary trends for the Meropenem Yearly Susceptibility Test Information Collection Program: a 10-year experience in the United States (1999-2008). Diagn Microbiol Infect Dis 2009; 65:414.
  9. Mera RM, Miller LA, Amrine-Madsen H, Sahm DF. Acinetobacter baumannii 2002-2008: increase of carbapenem-associated multiclass resistance in the United States. Microb Drug Resist 2010; 16:209.
  10. Pournaras S, Markogiannakis A, Ikonomidis A, et al. Outbreak of multiple clones of imipenem-resistant Acinetobacter baumannii isolates expressing OXA-58 carbapenemase in an intensive care unit. J Antimicrob Chemother 2006; 57:557.
  11. Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences. J Hosp Infect 2007; 65:204.
  12. Manikal VM, Landman D, Saurina G, et al. Endemic carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000; 31:101.
  13. Peleg AY, Franklin C, Bell JM, Spelman DW. Emergence of carbapenem resistance in Acinetobacter baumannii recovered from blood cultures in Australia. Infect Control Hosp Epidemiol 2006; 27:759.
  14. Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996; 9:148.
  15. Lesho E, Wortmann G, Moran K, Craft D. Fatal Acinetobacter baumannii infection with discordant carbapenem susceptibility. Clin Infect Dis 2005; 41:758.
  16. Corbella X, Montero A, Pujol M, et al. Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. J Clin Microbiol 2000; 38:4086.
  17. Linden PK, Paterson DL. Parenteral and inhaled colistin for treatment of ventilator-associated pneumonia. Clin Infect Dis 2006; 43 Suppl 2:S89.
  18. Horton J, Pankey GA. Polymyxin B, colistin, and sodium colistimethate. Med Clin North Am 1982; 66:135.
  19. Halstead DC, Abid J, Dowzicky MJ. Antimicrobial susceptibility among Acinetobacter calcoaceticus-baumannii complex and Enterobacteriaceae collected as part of the Tigecycline Evaluation and Surveillance Trial. J Infect 2007; 55:49.
  20. Cai Y, Chai D, Wang R, et al. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother 2012; 67:1607.
  21. Li J, Nation RL, Owen RJ, et al. Antibiograms of multidrug-resistant clinical Acinetobacter baumannii: promising therapeutic options for treatment of infection with colistin-resistant strains. Clin Infect Dis 2007; 45:594.
  22. Tacconelli E, Cataldo MA, De Pascale G, et al. Prediction models to identify hospitalized patients at risk of being colonized or infected with multidrug-resistant Acinetobacter baumannii calcoaceticus complex. J Antimicrob Chemother 2008; 62:1130.
  23. Dizbay M, Tunccan OG, Sezer BE, Hizel K. Nosocomial imipenem-resistant Acinetobacter baumannii infections: epidemiology and risk factors. Scand J Infect Dis 2010; 42:741.
  24. Vitkauskiene A, Dambrauskiene A, Cerniauskiene K, et al. Risk factors and outcomes in patients with carbapenem-resistant Acinetobacter infection. Scand J Infect Dis 2013; 45:213.
  25. Lemos EV, de la Hoz FP, Einarson TR, et al. Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and meta-analysis. Clin Microbiol Infect 2014; 20:416.
  26. Paterson DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006; 43 Suppl 2:S43.
  27. Hsueh PR, Teng LJ, Chen CY, et al. Pandrug-resistant Acinetobacter baumannii causing nosocomial infections in a university hospital, Taiwan. Emerg Infect Dis 2002; 8:827.
  28. Mugnier P, Poirel L, Pitout M, Nordmann P. Carbapenem-resistant and OXA-23-producing Acinetobacter baumannii isolates in the United Arab Emirates. Clin Microbiol Infect 2008; 14:879.
  29. Bonomo RA, Szabo D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clin Infect Dis 2006; 43 Suppl 2:S49.
  30. Jacoby GA, Munoz-Price LS. The new beta-lactamases. N Engl J Med 2005; 352:380.
  31. Peleg AY, Adams J, Paterson DL. Tigecycline Efflux as a Mechanism for Nonsusceptibility in Acinetobacter baumannii. Antimicrob Agents Chemother 2007; 51:2065.
  32. Adams MD, Nickel GC, Bajaksouzian S, et al. Resistance to colistin in Acinetobacter baumannii associated with mutations in the PmrAB two-component system. Antimicrob Agents Chemother 2009; 53:3628.
  33. Superti SV, Martins Dde S, Caierão J, et al. Indications of carbapenem resistance evolution through heteroresistance as an intermediate stage in Acinetobacter baumannii after carbapenem administration. Rev Inst Med Trop Sao Paulo 2009; 51:111.
  34. Fishbain J, Peleg AY. Treatment of Acinetobacter infections. Clin Infect Dis 2010; 51:79.
  35. Cisneros JM, Reyes MJ, Pachón J, et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996; 22:1026.
  36. Smolyakov R, Borer A, Riesenberg K, et al. Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment. J Hosp Infect 2003; 54:32.
  37. Jellison TK, Mckinnon PS, Rybak MJ. Epidemiology, resistance, and outcomes of Acinetobacter baumannii bacteremia treated with imipenem-cilastatin or ampicillin-sulbactam. Pharmacotherapy 2001; 21:142.
  38. Henwood CJ, Gatward T, Warner M, et al. Antibiotic resistance among clinical isolates of Acinetobacter in the UK, and in vitro evaluation of tigecycline (GAR-936). J Antimicrob Chemother 2002; 49:479.
  39. Wood GC, Hanes SD, Croce MA, et al. Comparison of ampicillin-sulbactam and imipenem-cilastatin for the treatment of acinetobacter ventilator-associated pneumonia. Clin Infect Dis 2002; 34:1425.
  40. Núñez ML, Martínez-Toldos MC, Bru M, et al. Appearance of resistance to meropenem during the treatment of a patient with meningitis by Acinetobacter. Scand J Infect Dis 1998; 30:421.
  41. Levin AS, Barone AA, Penço J, et al. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 1999; 28:1008.
  42. Garnacho-Montero J, Ortiz-Leyba C, Jiménez-Jiménez FJ, et al. Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP. Clin Infect Dis 2003; 36:1111.
  43. Florescu DF, Qiu F, McCartan MA, et al. What is the efficacy and safety of colistin for the treatment of ventilator-associated pneumonia? A systematic review and meta-regression. Clin Infect Dis 2012; 54:670.
  44. Falagas ME, Kasiakou SK. Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care 2006; 10:R27.
  45. Peleg AY, Potoski BA, Rea R, et al. Acinetobacter baumannii bloodstream infection while receiving tigecycline: a cautionary report. J Antimicrob Chemother 2007; 59:128.
  46. Seifert H, Stefanik D, Wisplinghoff H. Comparative in vitro activities of tigecycline and 11 other antimicrobial agents against 215 epidemiologically defined multidrug-resistant Acinetobacter baumannii isolates. J Antimicrob Chemother 2006; 58:1099.
  47. Karageorgopoulos DE, Kelesidis T, Kelesidis I, Falagas ME. Tigecycline for the treatment of multidrug-resistant (including carbapenem-resistant) Acinetobacter infections: a review of the scientific evidence. J Antimicrob Chemother 2008; 62:45.
  48. Navon-Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother 2007; 59:772.
  49. Anthony KB, Fishman NO, Linkin DR, et al. Clinical and microbiological outcomes of serious infections with multidrug-resistant gram-negative organisms treated with tigecycline. Clin Infect Dis 2008; 46:567.
  50. Lee YT, Tsao SM, Hsueh PR. Clinical outcomes of tigecycline alone or in combination with other antimicrobial agents for the treatment of patients with healthcare-associated multidrug-resistant Acinetobacter baumannii infections. Eur J Clin Microbiol Infect Dis 2013; 32:1211.
  51. Metan G, Alp E, Yildiz O, et al. Clinical experience with tigecycline in the treatment of carbapenem-resistant Acinetobacter infections. J Chemother 2010; 22:110.
  52. Curcio D, Fernández F, Vergara J, et al. Late onset ventilator-associated pneumonia due to multidrug-resistant Acinetobacter spp.: experience with tigecycline. J Chemother 2009; 21:58.
  53. De Pascale G, Montini L, Pennisi M, et al. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria. Crit Care 2014; 18:R90.
  54. FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. http://www.fda.gov/Drugs/DrugSafety/ucm224370.htm (Accessed on July 11, 2012).
  55. Prasad P, Sun J, Danner RL, Natanson C. Excess deaths associated with tigecycline after approval based on noninferiority trials. Clin Infect Dis 2012; 54:1699.
  56. Kmeid JG, Youssef MM, Kanafani ZA, Kanj SS. Combination therapy for Gram-negative bacteria: what is the evidence? Expert Rev Anti Infect Ther 2013; 11:1355.
  57. Bliziotis IA, Samonis G, Vardakas KZ, et al. Effect of aminoglycoside and beta-lactam combination therapy versus beta-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials. Clin Infect Dis 2005; 41:149.
  58. Durante-Mangoni E, Signoriello G, Andini R, et al. Colistin and rifampicin compared with colistin alone for the treatment of serious infections due to extensively drug-resistant Acinetobacter baumannii: a multicenter, randomized clinical trial. Clin Infect Dis 2013; 57:349.
  59. Aydemir H, Akduman D, Piskin N, et al. Colistin vs. the combination of colistin and rifampicin for the treatment of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia. Epidemiol Infect 2013; 141:1214.
  60. Motaouakkil S, Charra B, Hachimi A, et al. Colistin and rifampicin in the treatment of nosocomial infections from multiresistant Acinetobacter baumannii. J Infect 2006; 53:274.
  61. Bassetti M, Repetto E, Righi E, et al. Colistin and rifampicin in the treatment of multidrug-resistant Acinetobacter baumannii infections. J Antimicrob Chemother 2008; 61:417.
  62. Saballs M, Pujol M, Tubau F, et al. Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections. J Antimicrob Chemother 2006; 58:697.
  63. Bernabeu-Wittel M, Pichardo C, García-Curiel A, et al. Pharmacokinetic/pharmacodynamic assessment of the in-vivo efficacy of imipenem alone or in combination with amikacin for the treatment of experimental multiresistant Acinetobacter baumannii pneumonia. Clin Microbiol Infect 2005; 11:319.
  64. Kuo LC, Lai CC, Liao CH, et al. Multidrug-resistant Acinetobacter baumannii bacteraemia: clinical features, antimicrobial therapy and outcome. Clin Microbiol Infect 2007; 13:196.
  65. Itabashi S. [Clinical efficacy of prolonged (4 hour) drip infusion of meropenem against severe pneumonia]. Jpn J Antibiot 2007; 60:161.
  66. Chastre J, Wunderink R, Prokocimer P, et al. Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: a multicenter, randomized study. Crit Care Med 2008; 36:1089.
  67. Wang D. Experience with extended-infusion meropenem in the management of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii. Int J Antimicrob Agents 2009; 33:290.
  68. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388.
  69. Benifla M, Zucker G, Cohen A, Alkan M. Successful treatment of Acinetobacter meningitis with intrathecal polymyxin E. J Antimicrob Chemother 2004; 54:290.
  70. Kwa AL, Loh C, Low JG, et al. Nebulized colistin in the treatment of pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis 2005; 41:754.
  71. Pereira GH, Muller PR, Levin AS. Salvage treatment of pneumonia and initial treatment of tracheobronchitis caused by multidrug-resistant Gram-negative bacilli with inhaled polymyxin B. Diagn Microbiol Infect Dis 2007; 58:235.
  72. Lim SK, Lee SO, Choi SH, et al. The outcomes of using colistin for treating multidrug resistant Acinetobacter species bloodstream infections. J Korean Med Sci 2011; 26:325.
  73. Hanna H, Afif C, Alakech B, et al. Central venous catheter-related bacteremia due to gram-negative bacilli: significance of catheter removal in preventing relapse. Infect Control Hosp Epidemiol 2004; 25:646.
  74. Rodríguez Guardado A, Maradona JA, Asensi V, et al. [Postsurgical meningitis caused by Acinetobacter baumannii: study of 22 cases and review of the literature]. Rev Clin Esp 2001; 201:497.
  75. Kim BN, Peleg AY, Lodise TP, et al. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infect Dis 2009; 9:245.
  76. Jiménez-Mejías ME, Pichardo-Guerrero C, Márquez-Rivas FJ, et al. Cerebrospinal fluid penetration and pharmacokinetic/pharmacodynamic parameters of intravenously administered colistin in a case of multidrug-resistant Acinetobacter baumannii meningitis. Eur J Clin Microbiol Infect Dis 2002; 21:212.
  77. Ng J, Gosbell IB, Kelly JA, et al. Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. J Antimicrob Chemother 2006; 58:1078.
  78. Al Shirawi N, Memish ZA, Cherfan A, Al Shimemeri A. Post-neurosurgical meningitis due to multidrug-resistant Acinetobacter baumanii treated with intrathecal colistin: case report and review of the literature. J Chemother 2006; 18:554.
  79. Katragkou A, Roilides E. Successful treatment of multidrug-resistant Acinetobacter baumannii central nervous system infections with colistin. J Clin Microbiol 2005; 43:4916.
  80. Fernandez-Viladrich P, Corbella X, Corral L, et al. Successful treatment of ventriculitis due to carbapenem-resistant Acinetobacter baumannii with intraventricular colistin sulfomethate sodium. Clin Infect Dis 1999; 28:916.
  81. Wang AG, Wu CC, Liu JH. Bacterial corneal ulcer: a multivariate study. Ophthalmologica 1998; 212:126.
  82. Gopal L, Ramaswamy AA, Madhavan HN, et al. Postoperative endophthalmitis caused by sequestered Acinetobacter calcoaceticus. Am J Ophthalmol 2000; 129:388.
  83. Mahajan VM. Postoperative ocular infections: an analysis of laboratory data on 750 cases. Ann Ophthalmol 1984; 16:847.
  84. Mark DB, Gaynon MW. Trauma-induced endophthalmitis caused by Acinetobacter anitratus. Br J Ophthalmol 1983; 67:124.
  85. Miller J. Acinetobacter as a causative agent in preseptal cellulitis. Optometry 2005; 76:176.
  86. Mathews D, Mathews JP, Kwartz J, Inkster C. Preseptal cellulitis caused by Acinetobacter lwoffi. Indian J Ophthalmol 2005; 53:213.
  87. Bert F, Lambert-Zechovsky N. Sinusitis in mechanically ventilated patients and its role in the pathogenesis of nosocomial pneumonia. Eur J Clin Microbiol Infect Dis 1996; 15:533.
  88. Pneumatikos I, Konstantonis D, Tsagaris I, et al. Prevention of nosocomial maxillary sinusitis in the ICU: the effects of topically applied alpha-adrenergic agonists and corticosteroids. Intensive Care Med 2006; 32:532.
  89. Dandecha P, Sangthawan P. Peritonitis in acute peritoneal dialysis in a university hospital. J Med Assoc Thai 2002; 85:477.
  90. Galvao C, Swartz R, Rocher L, et al. Acinetobacter peritonitis during chronic peritoneal dialysis. Am J Kidney Dis 1989; 14:101.
  91. Valdez JM, Asperilla MO, Smego RA Jr. Acinetobacter peritonitis in patients receiving continuous ambulatory peritoneal dialysis. South Med J 1991; 84:607.
  92. Hartstein AI, Rashad AL, Liebler JM, et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med 1988; 85:624.
  93. Wendt C, Dietze B, Dietz E, Rüden H. Survival of Acinetobacter baumannii on dry surfaces. J Clin Microbiol 1997; 35:1394.
  94. Morgan DJ, Liang SY, Smith CL, et al. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol 2010; 31:716.
  95. Villegas MV, Hartstein AI. Acinetobacter outbreaks, 1977-2000. Infect Control Hosp Epidemiol 2003; 24:284.
  96. Otter JA, Yezli S, Schouten MA, et al. Hydrogen peroxide vapor decontamination of an intensive care unit to remove environmental reservoirs of multidrug-resistant gram-negative rods during an outbreak. Am J Infect Control 2010; 38:754.
  97. Urban C, Segal-Maurer S, Rahal JJ. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis 2003; 36:1268.