Acinetobacter baumannii: An Emerging Multidrug-resistant Threat

Thomas D Gootz; Andrea Marra

Disclosures

Expert Rev Anti Infect Ther. 2008;6(3):309-325. 

In This Article

Expert Commentary & Five-year View

The varied and complex factors outlined in this review are conspiring to disseminate multiple antibiotic resistance in many clinical populations of A. baumannii. Apparently, acquisition of novel resistance genes in combination with mutations(s) in intrinsic resistance factors that can change their expression or function, does not seem to compromise the ability of MDR A. baumannii to cause life-threatening infections. Numerous genomic islands described in this review that may be related to virulence or enhanced environmental survival also need to be further studied in order to elucidate their potential role in disease. A greater effort should be made to employ specific PCR molecular surveillance techniques to follow the spread of MDR strains more comprehensively. Most importantly of all, there appears to be very few new antimicrobials in development that offer meaningful improvements in treating these organisms. The best tool used to address MDR acinetobacters at the present time may rely most heavily on increased diligence and focus on implementing rigorous surveillance and disinfection programs within the hospital environment to limit the impact of MDR A. baumannii on our most vulnerable patients. The 5-year view of Acinetobacter research predicts that clinical strains will continue to become more resistant to all relevant classes of antimicrobials. Due to antibiotic selective pressure, MDR A. baumannii will become more widespread and more acutely involved in nosocomial infections. The 5-year view does not identify any highly active new antibiotics that will be effective against MDR Acinetobacter strains. This will result in the use of more off-label combinations of antibiotics that have demonstrated additive or synergistic activity in vitro. It is hoped that the near future will see more use of molecular techniques, such as PCR and gene sequencing, to identify those specific antibiotic-resistance genes that disseminate into clinical environments and have the most negative influence on the activity of existing antibiotics.

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