The road forward in the management of Acinetobacter infections in the ICU

Excerpt

Acinetobacter spp. infection is a global problem in ICUs, causing a variety of infections and presenting a challenge to effective therapy, because it is often a multidrug-resistant organism, that can lead to adverse patient outcomes. In the EPIC II point prevalence study of ICU infection, Acinetobacter spp. accounted for 8.8 % of all ICU organisms, with rates as high as 19 % in Asia and 17 % in Eastern Europe [1]. In one study of Asian ICUs, in patients with nosocomial pneumonia, Acinetobacter spp. infection was the most common cause of VAP, accounting for 36.5 % of all episodes overall, and nearly half of all episodes in Thailand [2]. Most of the clinically relevant ICU infections with this organism come from the Acinetobacter baumannii group of organisms. As the frequency of this infection has been rising, our therapeutic options have remained limited, and carbapenems (excluding ertapenem, which is not active against this organism) have been the drug of choice for these organisms, but are less effective than in the past, as resistance to these agents rises. Consequently, we have been forced to resort to therapies with polymyxins, and combinations of other agents (including sulbactam and tigecycline). …