[Nosocomial infections caused by Acinetobacter. Epidemiology and therapeutic difficulties]

Nosocomial infections due to Acinetobacter calcoaceticus are not easy to treat particularly in intensive-care and surgical units. Our study included 33 cases of nosocomial infections which developed during 1987 in the surgical intensive care unit and in the urology department. Acinetobacter was isolated from various types of nosocomial infections: urinary tract infections (43 per cent); septicaemia (15 per cent); surgical infections (27 per cent) and respiratory tract infections (15 per cent). Forty eight per cent of the patients received an antibiotic therapy and 52 per cent had no specific treatment. The following beta-lactam antibiotics were studied: ticarcilline, mezlocilline, cefotaxime and ceftazidime, and 83 per cent of the strains were TICRMEZRCTXR (phenotype IV). All the strains except one were imipenem susceptible. The study of aminoglycoside resistance in Acinetobacter showed that 91 per cent of the strains were gentamicin resistant (GENR); 25.5 per cent were gentamicin, and amikacin resistant and tobramycin susceptible (GENR AMKR TOBS, phenotype IV), and 45 per cent were GENR TOBR AMKR (phenotype V). Acinetobacter strains were resistant and 63 per cent pefloxacin resistant. Co-trimoxazole resistant strains represented 65 per cent of the strains. Should major antibiotics be used to treat nosocomial infections due to multiresistant Acinetobacter strains? Are prophylaxis, aseptic and surgical procedures sufficient to control these infections?