University of Barcelona, Hospital Clinic, School of Medicine, Department of Clinical Microbiology, Villarroel 170, Barcelona, Spain.
Expert Opin Pharmacother. 2012 Nov;13(16):2319-36. doi: 10.1517/14656566.2012.729820. Epub 2012 Oct 4.
Although the clinical importance of Acinetobacter pittii and Acinetobacter nosocomialis has increased in the nosocomial setting in the last decade, infections caused by Acinetobacter baumannii still have the highest clinical relevance. The most important features of this latter species are the ability to persist in the hospital environment and the multi-drug, extended-drug or pandrug resistance they may present which compromises the treatment of infections caused by this microorganism.
In the present review, the authors describe the molecular bases of the acquisition of resistant mechanisms as well as different current and potential future strategies to treat infections caused by multi-drug resistant A. baumannii.
With the increase in resistance to carbapenems, colistin has been extensively used, however some data suggest that the doses recommended are insufficient before a steady state is reached, suggesting that the administration of a loading dose on initiation of treatment may be beneficial. Combinations of antibacterial agents such as impenem plus sulbactam or imipenem plus colistin have been successfully used to treat VAP. Nonetheless, future alternatives for treating A. baumannii infections should be explored.
尽管在过去十年中，医院环境中不动杆菌属的临床重要性有所增加，但鲍曼不动杆菌引起的感染仍然具有最高的临床相关性。后者最重要的特征是能够在医院环境中存活以及它们可能表现出的多药、广泛耐药或泛耐药性，这会影响这种微生物引起的感染的治疗。
在本综述中，作者描述了获得耐药机制的分子基础，以及治疗多药耐药鲍曼不动杆菌引起的感染的当前和潜在未来策略。
随着碳青霉烯类药物耐药性的增加，多粘菌素已被广泛使用，但一些数据表明，在达到稳定状态之前，建议的剂量不足，这表明在开始治疗时给予负荷剂量可能是有益的。抗菌药物联合使用，如亚胺培南加舒巴坦或亚胺培南加多粘菌素，已成功用于治疗呼吸机相关性肺炎。然而，应该探索治疗鲍曼不动杆菌感染的未来替代方案。
