Acinetobacter: an old friend, but a new enemy
1Department of Clinical Microbiology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK. Kevin.Towner@nuh.nhs.uk
Abstract:
Acinetobacter emerged as a significant nosocomial pathogen during the late 1970s, probably as a consequence, at least in part, of increasing use of broad-spectrum antibiotics in hospitals. Most clinically significant isolates belong to the species Acinetobacter baumannii or its close relatives, with many infections concentrated in intensive care, burns or high dependency units treating severely ill or debilitated patients. Large outbreaks can occur in such units, involving the infection or colonisation of numerous patients by specific epidemic strains of A. baumannii. Recently, a particular problem has concerned cross-infection of injured military patients repatriated from combat regions of the world (e.g. Iraq and Afghanistan). Carbapenems have previously been the treatment of choice for infected patients, but increasing reports worldwide now describe A. baumannii isolates resistant to all conventional antimicrobial regimens. Data to support therapeutic use of the limited number of new antimicrobial agents (e.g. tigecycline) with in-vitro activity against these pathogens are still very limited. Detailed advice concerning prevention and control of outbreaks caused by multidrug-resistant strains of acinetobacter is available from the UK Health Protection Agency. In addition to antibiotic prescribing policies and audit, these measures focus on reinforcing standard infection control procedures and precautions, with particular attention to thorough cleaning of patient areas to take account of the long-term survival of acinetobacter after drying and inadequate disinfection. Despite these measures, the problem continues to escalate, with many hospitals worldwide now reporting outbreaks caused by multidrug-resistant strains of acinetobacter.
Insights
Acinetobacter baumannii is a growing hospital-acquired infection threat, especially multidrug-resistant strains. Enhanced infection control and antibiotic stewardship are crucial to combat escalating outbreaks in healthcare settings.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Acinetobacter emerged as a significant nosocomial pathogen in the late 1970s, linked to increased broad-spectrum antibiotic use.
- Clinically relevant Acinetobacter isolates, primarily Acinetobacter baumannii, frequently cause infections in intensive care, burns, and high-dependency units.
- Outbreaks of epidemic strains of Acinetobacter baumannii are common in these units, affecting severely ill patients.
Purpose of the Study:
- To highlight the escalating problem of multidrug-resistant Acinetobacter baumannii (MDR-AB) infections in healthcare settings.
- To discuss the challenges in treating infections caused by these resistant strains, including limited therapeutic options.
- To emphasize the importance of infection control and prevention strategies in managing Acinetobacter outbreaks.
Main Methods:
- Review of clinical observations and epidemiological data regarding Acinetobacter infections.
- Analysis of antimicrobial resistance patterns, particularly carbapenem resistance in Acinetobacter baumannii.
- Evaluation of current infection control guidelines and their effectiveness.
Main Results:
- Increasing global reports of Acinetobacter baumannii isolates resistant to all conventional antimicrobial agents.
- Limited clinical data supporting the efficacy of newer agents like tigecycline against multidrug-resistant strains.
- Persistent challenges in preventing and controlling outbreaks despite adherence to infection control measures.
Conclusions:
- Multidrug-resistant Acinetobacter baumannii poses a significant and escalating threat in healthcare facilities worldwide.
- Effective management requires robust antibiotic stewardship, stringent infection control, and improved disinfection protocols.
- Further research is needed to develop and validate new therapeutic strategies against these challenging pathogens.
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