Clinical Management of Acinetobacter Infections

Acinetobacter spp., notably Acinetobacter baumannii, are opportunistic pathogens of critical concern in hospital settings owing to intrinsic and acquired resistance to multiple antimicrobials. Clinical manifestations include ventilator-associated pneumonia, bloodstream infections and wound infections, often in intensive care units. Management relies on early identification using molecular or mass-spectrometry methods and on tailored antibiotic regimens such as carbapenem combinations, polymyxins or tigecycline. However, the emergence of carbapenem-resistant strains has severely limited options and increased mortality. Adjunctive strategies encompass antimicrobial stewardship to optimise dosing and minimise resistance, and rigorous infection control measures including surface decontamination, hand hygiene and equipment sterilisation. Novel approaches under evaluation include bacteriophage therapy and anti-virulence agents aimed at disrupting biofilms or resistance mechanisms. Surveillance of resistance trends at local and regional levels informs empirical therapy, while therapeutic drug monitoring supports the balance between efficacy and toxicity. Clinical guidelines increasingly advocate combination therapy for severe or refractory cases, yet optimum regimens remain to be defined. Overall, an integrated approach combining diagnostics, pharmacological innovation and robust infection prevention is essential to confront the global threat posed by Acinetobacter infections.

Research from Nature Portfolio

Recent studies have shown that antibiotic-resistant A. baumannii strains exhibit heightened susceptibility to environmental bacteriophages. A comparative analysis of clinical isolates revealed that strains resistant to four or more antibiotics were infectable by a broader diversity of phages than sensitive strains, suggesting an evolutionary trade-off. Phage susceptibility patterns also correlated with distinct resistance profiles, indicating that bacteriophage typing may serve as a rapid adjunct to antimicrobial susceptibility testing. These findings support the potential of phage therapy as an adjunctive strategy in the management of multidrug-resistant Acinetobacter infections.

Clinical Management of Acinetobacter Infections publication trend

The graph below shows the total number of articles in clinical management of acinetobacter infections across all publications each year (not limited to Nature Index journals).

Technical terms

Carbapenem-resistant Acinetobacter baumannii (CRAb): A strain of A. baumannii that produces enzymes which inactivate carbapenem antibiotics, resulting in high-level resistance.

Bacteriophage: A virus that specifically infects and lyses bacteria, explored as a potential therapeutic agent against drug-resistant infections.

Biofilm: A structured community of bacterial cells enclosed in a self-produced polymeric matrix adhering to surfaces and contributing to antimicrobial tolerance.

Desiccation tolerance: The ability of bacteria to survive extended periods of dryness on inanimate surfaces, facilitating persistence in clinical environments.

Antimicrobial stewardship: Coordinated interventions designed to optimise antibiotic use, improve patient outcomes and minimise the emergence of resistance.

References

1. Clinical Antibiotic-resistant Acinetobacter baumannii Strains with Higher Susceptibility to Environmental Phages than Antibiotic-sensitive Strains. Scientific Reports (2017).
2. Environmental contamination with carbapenem resistant Acinetobacter baumannii in healthcare settings in Fiji: a potential source of infection. Frontiers in Cellular and Infection Microbiology (2024).
3. Healthcare Equipment and Personnel Reservoirs of Carbapenem-Resistant Acinetobacter baumannii Epidemic Clones in Intensive Care Units in a Tunisian Hospital. Microorganisms (2023).