Managing Difficult-to-Treat Acinetobacter Infections: From MIC-Guided Therapy to Procalcitonin Monitoring
This mini-review addresses the clinical challenge of Acinetobacter infections, where most isolates resist standard antibiotics and distinguishing colonization from true infection is difficult. The authors advocate using clinical parameters alongside procalcitonin to confirm active infection before initiating directed therapy, emphasizing that combination regimens guided by detailed antibiograms and MIC values are essential. Despite Acinetobacter's reputation as a colonizer, attributable mortality is high, demanding prompt targeted treatment.
The original study
The challenges of difficult-to-treat
- Authors
- Richards GA, Perovic O, Brink AJ
- Journal
- Clinical microbiology reviews
- Type
- Journal Article, Review
- PMID
- 39555919
Original abstract
SUMMARYInfections due to Acinetobacter spp. are among the most difficult to treat. Most are resistant to standard antibiotics, and there is difficulty in distinguishing colonizers from pathogens. This mini-review examines the available antibiotics that exhibit activity against these organisms and provides guidance as to which cultures are relevant and how to treat active infections. Antibiograms describing resistance mechanisms and the minimum inhibitory concentration (MIC) are essential to determine which agent or combination of agents should be used after confirmation of infection, utilizing clinical parameters and biomarkers such as procalcitonin. Directed therapy should be prompt as despite its reputation as a colonizer, the attributable mortality is high. However, although combination therapy is advised, no specific combination has definite evidence of superiority.