Dear Editor,
Recently, we have gone through the article published in your esteemed journal. The author very briefly described the seriousness of infection caused by Acinetobacter baumanni complex organism and their current situation in antimicrobial resistance.[1] As our experience with Acinetobacter species.
The COVID-19 pandemic, which affected the entire globe between 2020 and 2023, continues to have residual impacts due to the emergence of new variants.[2] However, an equally significant but less recognized threat has been developing over the past few decades: the rise of antibiotic-resistant bacteria. The fight against bacteria began with Alexander Fleming’s discovery of penicillin, the first antibiotic.[3] As new antibiotics were discovered, bacteria began to mutate to survive, leading to the emergence of ESKAPE (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter species, Pseudomonas aeruginosa, and Enterobacter species) pathogens.[1] These pathogens are commonly found in healthcare environments and can cause opportunistic infections in hospitalized patients. Most of these hospital-acquired pathogens are multidrug-resistant, with only a limited number of antibiotics effective against them. While these pathogens can also be community-acquired, these strains are typically less resistant.
Hospital-acquired ESKAPE pathogens, particularly Acinetobacter baumannii complex and Pseudomonas aeruginosa, are non-fermenters, making their treatment more challenging when they are multidrug-resistant (MDR). The situation becomes even more complex when a patient is co-infected with both non-fermenters, leaving only one or two drugs for treatment due to intrinsic resistance.[4] Hospital-acquired MDR Acinetobacter baumannii complex is resistant to cephalosporins, fluoroquinolones, beta-lactam (BL) + BL Inhibiter combinations, aminoglycosides, and/or carbapenems. It is intrinsically resistant to aminopenicillin, amoxicillin/clavulanic acid, nitrofurantoin, fosfomycin, aztreonam, and chloramphenicol.[5] The only remaining treatment options are polymyxins (colistin and polymyxin B) and tigecycline, with or without amikacin. Without a combination of higher antibiotics, the chances of successfully treating an MDR Acinetobacter infection are slim. The newer colistin-sparing combination of ceftazidime and avibactam, along with the aztreonam synergy effect, is used for carbapenem-resistant bacterial infections, though it is ineffective against Acinetobacter species due to intrinsic resistance.[5]
So, how should patients be treated? In most cases, these are hospital-acquired infections, often resulting from contamination or colonization of Acinetobacter species on medical devices. If the source is removed, the infection is usually self-limiting. If the patient is moved away from the hospital environment, the infection will subside. According to various infection control practices, prevention is the best strategy when effective treatment is not available. Proper hand hygiene and careful handling of devices can reduce the risk of MDR Acinetobacter infection in patients.[6] This should be maintained by patients, their caregivers, and their surroundings to decrease the risk of Acinetobacter infection re-emergence.
So we conclude, the discovery or invention of new antibiotics to treat ESKAPE including MDR Acinetobacter infection is urgently needed; however, until such advancements are made, prevention remains the focal point.
Comments on: Antimicrobial-resistant Acinetobacter: where do we go next?
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References
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