Acinetobacter baumannii complex: Difference between revisions

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Acinetobacter baumannii complex
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* [[Aminoglycosides]] may not penetrate well into lungs and brain, so are usually avoided
 
* [[Aminoglycosides]] may not penetrate well into lungs and brain, so are usually avoided
 
* [[Bacteriophages]] are promising
 
* [[Bacteriophages]] are promising
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  +
=== Carbapenem-Resistant ''Acinetobacter baumannii'' ===
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* Infection must be distinguished from colonization of the airway or wound
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* Resistance may be mediated by a number of [[β-lactamases]], including OXA-24/40-like carbapenemases, OCA-23-like carbapenemases, and metallo-β-lactamases, and often has [[sulbactam]] resistance
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* Often have concurrent aminoglycoside-modifying enzymes or 16S rRNA methyltransferases, which confer resistance to [[aminoglycosides]] including [[plazomicin]]
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* Single-agent treatment may be sufficient for mild infections
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** High-dose [[ampicillin-sulbactam]] is preferred, at a dose of either 9 g IV q8h infused over 4 hours, or 27 g IV q24h continuous infusion
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* Combination treatment with at least two agents that have ''in vitro'' activity for most other infections
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** Options include [[ampicillin-sulbactam]] (preferred), [[minocycline]], [[tigecycline]], [[polymyxin B]], and [[cefidercocol]]
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** [[Ampicillin-sulbactam]] may remain effective in non-susceptible isolates when used at high doses
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** [[Fosfomycin]] and [[rifampin]] are not recommended
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** After clinical improvement, step down to single-agent therapy
 
{{DISPLAYTITLE:''Acinetobacter baumannii'' complex}}
 
{{DISPLAYTITLE:''Acinetobacter baumannii'' complex}}
 
[[Category:Gram-negative bacilli]]
 
[[Category:Gram-negative bacilli]]

Revision as of 16:30, 24 November 2021

Background

Microbiology

Management

Carbapenem-Resistant Acinetobacter baumannii

  • Infection must be distinguished from colonization of the airway or wound
  • Resistance may be mediated by a number of β-lactamases, including OXA-24/40-like carbapenemases, OCA-23-like carbapenemases, and metallo-β-lactamases, and often has sulbactam resistance
  • Often have concurrent aminoglycoside-modifying enzymes or 16S rRNA methyltransferases, which confer resistance to aminoglycosides including plazomicin
  • Single-agent treatment may be sufficient for mild infections
    • High-dose ampicillin-sulbactam is preferred, at a dose of either 9 g IV q8h infused over 4 hours, or 27 g IV q24h continuous infusion
  • Combination treatment with at least two agents that have in vitro activity for most other infections