UMEM Educational Pearls

Category: Critical Care

Title: Acinetobacter

Keywords: acinetobacter, polymixin, ventilator-associated pneumonia, bacteremia (PubMed Search)

Posted: 6/3/2008 by Mike Winters, MD (Updated: 8/12/2020)
Click here to contact Mike Winters, MD

Acinetobacter in the Critically Ill

  • As all of us know, there has been an alarming increase in the incidence of acinetobacter infections
  • At present, infections mostly occur in ICU/critically ill patients
  • Important risk factors for colonization and infection include mechanical ventilation, recent surgery, tracheostomy, residents of long-term care facilities, central venous catheterization, and enteral feedings
  • The most frequent clinical manifestations are ventilator associated pneumonia and bacteremia
  • Susceptible strains can be treated with a broad-spectrum cephalosporin, carbapenem, or B-lactam-B-lactamase used alone or in combination with an aminoglycoside
  • For resistant strains, the most active agent in vitro are the polymyxins
  • The most common adverse effect of the polymyxins is nephrotoxicity (up to 36%)
  • Tigecycline has been used but resistance rates are rapidly increasing

References

Munoz-Price LS, Weinstein RA. Acinetobacter infection. NEJM 2008;358:1271-81.