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 |
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* [[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 |
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{{DISPLAYTITLE:''Acinetobacter baumannii'' complex}} |
{{DISPLAYTITLE:''Acinetobacter baumannii'' complex}} |
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[[Category:Gram-negative bacilli]] |
[[Category:Gram-negative bacilli]] |
Revision as of 16:30, 24 November 2021
Background
Microbiology
- Contains Acinetobacter baumannii, Acinetobacter nosocomialis, and Acinetobacter pittii
- Non-motile, non-fermenting Gram-negative bacillus
Management
- Choice of antibiotic depends on susceptibility testing
- Possible options include:
- Cefepime, ceftriaxone, and cefotaxime
- Cefiderocol
- Carbapenems
- Tigecycline
- Colistin and polymyxin B (though Acinetobacter junii has inherent resistance)
- Aminoglycosides may not penetrate well into lungs and brain, so are usually avoided
- Bacteriophages are promising
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
- Options include ampicillin-sulbactam (preferred), minocycline, tigecycline, polymyxin B, and cefidercocol
- Ampicillin-sulbactam may remain effective in non-susceptible isolates when used at high doses
- Fosfomycin and rifampin are not recommended
- After clinical improvement, step down to single-agent therapy