TY - JOUR
T1 - Carbapenem-resistant Acinetobacter baumannii
T2 - Colonization, Infection and Current Treatment Options
AU - Bartal, Carmi
AU - Rolston, Kenneth V.I.
AU - Nesher, Lior
N1 - Funding Information:
No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Carmi Bartal performed the literature search; Carmi Bartal, Kenneth Rolston and Lior Nesher created the table and figure and wrote the manuscript. Carmi Bartal and Kenneth Rolston have nothing to declare; Lior Nesher has given educational lectures at conferences and participated in advisory boards paid for by Pfizer, Merck and Gilead, none of which relate to the topic of this manuscript. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Carbapenem-resistant Acinetobacter baumannii (CRAB) causes colonization and infection predominantly in hospitalized patients. Distinction between the two is a challenge. When CRAB is isolated from a non-sterile site (soft tissue, respiratory samples, etc.), it probably represents colonization unless clear signs of infection (fever, elevated white blood count, elevated inflammatory markers and abnormal imaging) are present. Treatment is warranted only for true infections. In normally sterile sites (blood, cerebrospinal fluid) the presence of indwelling medical devices (catheters, stents) should be considered when evaluating positive cultures. In the absence of such devices, the isolate represents an infection and should be treated. If an indwelling device is present and there are no signs of active infection, the device should be replaced if possible, and no treatment is required. If there are signs of an active infection the device should be removed or replaced, and treatment should be administered. Current treatments options and clinical data are limited. No agent or combination regimen has been shown to be superior to any other in randomized clinical trials. Ampicillin-sulbactam appears to have the best evidence for initial use. This is probably due to its ability to saturate penicillin-binding proteins 1 and 3 when given in high dose. Tigecycline when used should be given in high dose as well. Polymyxins are a treatment option but are difficult to dose correctly and have significant side effects. Newer treatment options such as eravacycline and cefiderocol have potential; however, currently there are not enough data to support their use as single agents. Combination therapy appears to be the best treatment option and should always include high-dose ampicillin-sulbactam combined with another active agent such as high-dose tigecycline, polymyxins, etc. These infections require a high complexity of skill, and an infectious disease specialist should be involved in the management of these patients.
AB - Carbapenem-resistant Acinetobacter baumannii (CRAB) causes colonization and infection predominantly in hospitalized patients. Distinction between the two is a challenge. When CRAB is isolated from a non-sterile site (soft tissue, respiratory samples, etc.), it probably represents colonization unless clear signs of infection (fever, elevated white blood count, elevated inflammatory markers and abnormal imaging) are present. Treatment is warranted only for true infections. In normally sterile sites (blood, cerebrospinal fluid) the presence of indwelling medical devices (catheters, stents) should be considered when evaluating positive cultures. In the absence of such devices, the isolate represents an infection and should be treated. If an indwelling device is present and there are no signs of active infection, the device should be replaced if possible, and no treatment is required. If there are signs of an active infection the device should be removed or replaced, and treatment should be administered. Current treatments options and clinical data are limited. No agent or combination regimen has been shown to be superior to any other in randomized clinical trials. Ampicillin-sulbactam appears to have the best evidence for initial use. This is probably due to its ability to saturate penicillin-binding proteins 1 and 3 when given in high dose. Tigecycline when used should be given in high dose as well. Polymyxins are a treatment option but are difficult to dose correctly and have significant side effects. Newer treatment options such as eravacycline and cefiderocol have potential; however, currently there are not enough data to support their use as single agents. Combination therapy appears to be the best treatment option and should always include high-dose ampicillin-sulbactam combined with another active agent such as high-dose tigecycline, polymyxins, etc. These infections require a high complexity of skill, and an infectious disease specialist should be involved in the management of these patients.
KW - Acinetobacter infections
KW - Carbapenem-resistant enterobacteriaceae
KW - Drug resistance
KW - Multiple
UR - http://www.scopus.com/inward/record.url?scp=85124735929&partnerID=8YFLogxK
U2 - 10.1007/s40121-022-00597-w
DO - 10.1007/s40121-022-00597-w
M3 - Review article
C2 - 35175509
AN - SCOPUS:85124735929
SN - 2193-8229
VL - 11
SP - 683
EP - 694
JO - Infectious Diseases and Therapy
JF - Infectious Diseases and Therapy
IS - 2
ER -
