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      Insight into Acinetobacter baumannii: pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities

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          Abstract

          Acinetobacter baumannii, once considered a low-category pathogen, has emerged as an obstinate infectious agent. The scientific community is paying more attention to this pathogen due to its stubbornness to last resort antimicrobials, including carbapenems, colistin, and tigecycline, its high prevalence of infections in the hospital setting, and significantly increased rate of community-acquired infections by this organism over the past decade. It has given the fear of pre-antibiotic era to the world. To further enhance our understanding about this pathogen, in this review, we discuss its taxonomy, pathogenesis, current treatment options, global resistance rates, mechanisms of its resistance against various groups of antimicrobials, and future therapeutics.

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          Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options.

          Lisa Maragakis, Trish Perl (2008)
          Multidrug-resistant Acinetobacter baumannii is recognized to be among the most difficult antimicrobial-resistant gram-negative bacilli to control and treat. Increasing antimicrobial resistance among Acinetobacter isolates has been documented, although definitions of multidrug resistance vary in the literature. A. baumannii survives for prolonged periods under a wide range of environmental conditions. The organism causes outbreaks of infection and health care-associated infections, including bacteremia, pneumonia, meningitis, urinary tract infection, and wound infection. Antimicrobial resistance greatly limits the therapeutic options for patients who are infected with this organism, especially if isolates are resistant to the carbapenem class of antimicrobial agents. Because therapeutic options are limited for multidrug-resistant Acinetobacter infection, the development or discovery of new therapies, well-controlled clinical trials of existing antimicrobial regimens and combinations, and greater emphasis on the prevention of health care-associated transmission of multidrug-resistant Acinetobacter infection are essential.
          Article 0 comments Cited 303 times – based on 0 reviews     Review now
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            Surveillance for severe acute respiratory infections (SARI) in hospitals in the WHO European region - an exploratory analysis of risk factors for a severe outcome in influenza-positive SARI cases

            Tamara J Meerhoff, Artan Simaku, Dritan Ulqinaku … (2015)
            Background The 2009 H1N1 pandemic highlighted the need to routinely monitor severe influenza, which lead to the establishment of sentinel hospital-based surveillance of severe acute respiratory infections (SARI) in several countries in Europe. The objective of this study is to describe characteristics of SARI patients and to explore risk factors for a severe outcome in influenza-positive SARI patients. Methods Data on hospitalised patients meeting a syndromic SARI case definition between 2009 and 2012 from nine countries in Eastern Europe (Albania, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russian Federation and Ukraine) were included in this study. An exploratory analysis was performed to assess the association between risk factors and a severe (ICU, fatal) outcome in influenza-positive SARI patients using a multivariate logistic regression analysis. Results Nine countries reported a total of 13,275 SARI patients. The majority of SARI patients reported in these countries were young children. A total of 12,673 SARI cases (95%) were tested for influenza virus and 3377 (27%) were laboratory confirmed. The majority of tested SARI cases were from Georgia, the Russian Federation and Ukraine and the least were from Kyrgyzstan. The proportion positive varied by country, season and age group, with a tendency to a higher proportion positive in the 15+ yrs age group in six of the countries. ICU admission and fatal outcome were most often recorded for influenza-positive SARI cases aged >15 yrs. An exploratory analysis using pooled data from influenza-positive SARI cases in three countries showed that age > 15 yrs, having lung, heart, kidney or liver disease, and being pregnant were independently associated with a fatal outcome. Conclusions Countries in Eastern Europe have been able to collect data through routine monitoring of severe influenza and results on risk factors for a severe outcome in influenza-positive SARI cases have identified several risk groups. This is especially relevant in the light of an overall low vaccination uptake and antiviral use in Eastern Europe, since information on risk factors will help in targeting and prioritising vulnerable populations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0722-x) contains supplementary material, which is available to authorized users.
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              Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies.

              Yun Cai, Dong Chai, Rui Wang … (2012)
              Colistin is the last resort for treatment of multidrug-resistant Acinetobacter baumannii. Unfortunately, resistance to colistin has been reported all over the world. The highest resistance rate was reported in Asia, followed by Europe. The heteroresistance rate of A. baumannii to colistin is generally higher than the resistance rate. The mechanism of resistance might be loss of lipopolysaccharide or/and the PmrAB two-component system. Pharmacokinetic/pharmacodynamic studies revealed that colistin monotherapy is unable to prevent resistance, and combination therapy might be the best antimicrobial strategy against colistin-resistant A. baumannii. Colistin/rifampicin and colistin/carbapenem are the most studied combinations that showed promising results in vitro, in vivo and in the clinic. New peptides showing good activity against colistin-resistant A. baumannii are also being investigated.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Drug Resist
                Journal ID (iso-abbrev): Infect Drug Resist
                Journal ID (publisher-id): Infection and Drug Resistance
                Title: Infection and Drug Resistance
                Publisher: Dove Medical Press
                ISSN (Electronic): 1178-6973
                Publication date Collection: 2018
                Publication date (Electronic): 21 August 2018
                Volume: 11
                Pages: 1249-1260
                Affiliations
                [1 ]Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan, shafiq.mmg@ 123456pu.edu.pk
                [2 ]Department of Pathology, King Edward Medical University, Lahore, Pakistan
                [3 ]Department of Microbiology, Hazara University, Mansehra, Pakistan
                Author notes
                Correspondence: Shafiq Ur Rehman, Department of Microbiology and Molecular Genetics, University, of the Punjab, New Campus, Canal Bank Road PO Box No. 54590, Lahore, Punjab, Pakistan, Tel +92 321 490 5423, Email shafiq.mmg@ 123456pu.edu.pk
                Article
                Publisher ID: idr-11-1249
                DOI: 10.2147/IDR.S166750
                PMC ID: 6110297
                PubMed ID: 30174448
                SO-VID: 44922534-aa37-4797-8ad7-7bdc6e8ec2d5
                Copyright © © 2018 Asif et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Subject: Review

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: antibiotic resistance,colistin,tigecycline,phage therapy
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: antibiotic resistance, colistin, tigecycline, phage therapy

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