Keywords
How to Cite
Abstract
Acinetobacter baumannii extensively drug-resistant (XDR) is an agent that has gained importance in intensive care units (ICU) due to its profile of resistance, virulence and adverse effects of the available treatments. Being considered a global public health problem. Therefore it is necessary to determine which of the therapeutic alternatives is safer and more efficient. A narrative review of the literature was performed with the objetive to illustrate the therapeutic efficacy of colistin in XDR Acinetobacter baumannii infection in ICU patients and evaluate possible therapeutic alternatives. Evidence shows that the best choice of treatment is colistin monotherapy due to its efficacy although it is highly nephrotoxic. There are alternatives such as tigecycline and doripenem, but they have lower efficacy. It was concluded that colistin monotherapy must be the first line of treatment, although multitherapy has demonstrated efficacy, greater evidence is needed on its usefulness and clinical management.
Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: n international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 1 de
marzo de 2012;18(3):268-81.
Khawcharoenporn T, Pruetpongpun N,
Tiamsak P, Rutchanawech S, Mundy
LM, Apisarnthanarak A. Colistin-based
treatment for extensively drug-resistant
Acinetobacter baumannii pneumonia.
Int J Antimicrob Agents. abril de
;43(4):378-82.
Chen K-J, Hou C-H, Sun M-H, Lai C-C,
Sun C-C, Hsiao C-H. Endophthalmitis
caused by Acinetobacter baumannii: Report
of two cases. J Clin Microbiol. 1 de
marzo de 2008;46(3):1148-50.
Ng TM, Teng CB, Lye DC, Apisarnthanarak
A. A multicenter casecase
control study for risk factors and
outcomes of extensively drug-resistant
Acinetobacter baumannii bacteremia.
Infect Control Hosp Epidemiol.
;35(1):49-55.
Cisneros JM, Pachón J. [Acinetobacter
baumannii: a nosocomial
pathogen difficult to control]. Enfermedades
Infecc Microbiol Clínica. mayo de
;21(5):221-3.
Fournier PE, Richet H. The epidemiology
and control of Acinetobacter baumannii
in health care facilities. Clin Infect Dis
Off Publ Infect Dis Soc Am. 1 de marzo
de 2006;42(5):692-9.
Enríquez AR, Benítez CR. Neumonía
asociada a ventilación mecánica por Acinetobacter
baumannii MDR en una unidad
de terapia intensiva de tercer nivel.
Acta Médica Grupo Ángeles. 25 de mayo
de 2010;12(2):57-64.
Torres AH, Vázquez EG, Yagüe G, Gómez
JG. Acinetobacter baumanii multirresistente: situación clínica actual y
nuevas perspectivas. Rev Esp Quimioter.
;23(1):12-9.
Shields RK, Clancy CJ, Gillis LM, Kwak
EJ, Silveira FP, Massih RCA, et al. Epidemiology,
clinical characteristics and
outcomes of extensively drug-resistant
Acinetobacter baumannii infections
among solid organ transplant recipients.
PloS One. 2012;7(12):e52349.
Stietz MS, Ramírez MS, Vilacoba E,
Merkier AK, Limansky AS, Centrón D,
et al. Acinetobacter baumannii extensively
drug resistant lineages in Buenos
Aires hospitals differ from the international
clones I-III. Infect Genet Evol J
Mol Epidemiol Evol Genet Infect Dis.
marzo de 2013;14:294-301.
Solomennyi A, Goncharov A, Zueva L.
Extensively drug-resistant Acinetobacter
baumannii belonging to the international
clonal lineage I in a Russian burn intensive
care unit. Int J Antimicrob Agents.
;45(5):525-8.
Li Y, Guo Q, Wang P, Zhu D, Ye X, Wu S,
et al. Clonal dissemination of extensively
drug-resistant Acinetobacter baumannii
producing an OXA-23 b-lactamase
at a teaching hospital in Shanghai,
China. J Microbiol Immunol Infect Wei
Mian Yu Gan Ran Za Zhi. febrero de
;48(1):101-8.
Ni W, Shao X, Di X, Cui J, Wang R,
Liu Y. In vitro synergy of polymyxins
with other antibiotics for Acinetobacter
baumannii: a systematic review and
meta-analysis. Int J Antimicrob Agents.
enero de 2015;45(1):8-18.
Hamidian M, Holt KE, Pickard D, Dougan
G, Hall RM. A GC1 Acinetobacter
baumannii isolate carrying AbaR3 and
the aminoglycoside resistance transposon
TnaphA6 in a conjugative plasmid.
J Antimicrob Chemother. abril de
;69(4):955-8.
Martins N, Martins IS, de Freitas WV, de
Matos JA, Magalhães ACG, Girão VBC,
et al. Severe infection in a lung transplant
recipient caused by donor-transmitted
carbapenem-resistant Acinetobacter baumannii.
Transpl Infect Dis Off J Transplant
Soc. junio de 2012;14(3):316-20.
Park YS, Lee H, Lee KS, Hwang SS,
Cho YK, Kim HY, et al. Extensively
drug-resistant Acinetobacter baumannii:
risk factors for acquisition and prevalent
OXA-type carbapenemases--a multicentre
study. Int J Antimicrob Agents. noviembre
de 2010;36(5):430-5.
Zhou H-Y, Yuan Z, Du Y-P. Prior use of
four invasive procedures increases the
risk of Acinetobacter baumannii nosocomial
bacteremia among patients in
intensive care units: a systematic review
and meta-analysis. Int J Infect Dis IJID
Off Publ Int Soc Infect Dis. mayo de
;22:25-30.
Sheng W-H, Liao C-H, Lauderdale T-L,
Ko W-C, Chen Y-S, Liu J-W, et al. A multicenter
study of risk factors and outcome
of hospitalized patients with infections
due to carbapenem-resistant Acinetobacter
baumannii. Int J Infect Dis IJID Off
Publ Int Soc Infect Dis. septiembre de
;14(9):e764-9.
Prado A, Arias NL, Chávez M, Cabrera
CE, Gómez RF. Caracterización fenotípica
de aislamientos de Acinetobacter
baumannii en una institución de salud de
alta complejidad de Cali. Biomédica. 13
de noviembre de 2013;34(0):101-7.
Pinzón JO, Mantilla JR, Valenzuela
EM, Fernández F, Arturo Álvarez C,
Osorio EDJ. Molecular characterization
of Acinetobacter baumannii isolations
from a burns unit in a third level attention hospital in Bogotá. Infectio. junio de
;10(2):71-8.
Villegas MV, Kattan JN, Correa A, Lolans
K, Guzman AM, Woodford N, et al. Dissemination
of Acinetobacter baumannii
clones with OXA-23 Carbapenemase in
Colombian hospitals. Antimicrob Agents
Chemother. junio de 2007;51(6):2001-4.
Rodríguez CH, Nastro M, Weyland B,
Losada M, Vay C, Famiglietti A. Bacteriemias
causadas por Acinetobacter
spp. y resistencia a carbapenemes. Acta
Bioquímica Clínica Latinoam. junio de
;44(2):243-8.
Rodríguez CH, Bombicino K, Granados
G, Vay C, Famiglietti A. Evaluación
microbiológica y epidemiológica de los
clones de Acinetobacter baumannii resistentes
a los carbapenemes aislados
en la unidad de cuidados intensivos de
un Hospital Universitario de la ciudad
de Buenos Aires. Rev Argent Microbiol.
septiembre de 2009;41(3):151-5.
Hart Casares M, Llanes Rodríguez N, Espinosa
Rivera F, Halley Posada M del C,
Martínez Batista ML, López Suárez AL.
Estudio de la sensibilidad antimicrobiana
de la especie Acinetobacter baumannii en
el Hospital “Hermanos Ameijeiras”, año
Rev Cuba Med [internet]. septiembre
de 2008;47(3). Disponible en: http://
scielo.sld.cu/scielo.php?script=sci_arttex
t&pid=S0034-75232008000300007
Domínguez YM, Sepúlveda AM, Bello
TH, González RG, Mella MS, Zemelman
ZR. Aislamiento de Acinetobacter
spp. desde muestras clínicas en el Hospital
Clínico Regional “Guillermo Grant
Benavente”, Concepción. Rev Chil Infectol.
enero de 2000;17(4):321-5.
Ortwine JK, Kaye KS, Li J, Pogue JM.
Colistin: Understanding and applying recent
pharmacokinetic advances. Pharmacother
J Hum Pharmacol Drug Ther. 1 de
enero de 2015;35(1):11-6.
Falagas ME, Grammatikos AP, Michalopoulos
A. Potential of old-generation
antibiotics to address current need for
new antibiotics. Expert Rev Anti Infect
Ther. 1 de octubre de 2008;6(5):593-600.
Eadon MT, Hack BK, Alexander JJ, Xu
C, Dolan ME, Cunningham PN. Cell cycle
arrest in a model of colistin nephrotoxicity.
Physiol Genomics. 1 de octubre
de 2013;45(19):877-88.
Tuon FF, Rigatto MH, Lopes CK, Kamei
LK, Rocha JL, Zavascki AP. Risk factors
for acute kidney injury in patients treated
with polymyxin B or colistin methanesulfonate
sodium. Int J Antimicrob Agents.
de abril de 2014;43(4):349-52.
Michalopoulos AS, Falagas ME. Colistin:
Recent data on pharmacodynamics
properties and clinical efficacy in critically
ill patients. Ann Intensive Care.
;1(1):30.
Batirel A, Balkan II, Karabay O, Agalar
C, Akalin S, Alici O, et al. Comparison
of colistin-carbapenem, colistin-sulbactam,
and colistin plus other antibacterial
agents for the treatment of extremely
drug-resistant Acinetobacter baumannii
bloodstream infections. Eur J Clin Microbiol
Infect Dis Off Publ Eur Soc Clin
Microbiol. agosto de 2014;33(8):1311-
Garnacho-Montero J, Ortiz-Leyba C,
Jiménez-Jiménez FJ, Barrero-Almodóvar
AE, García-Garmendia JL, Bernabeu-
WittelI M, et al. Treatment of multidrug-
resistant Acinetobacter baumannii
ventilator-associated pneumonia (VAP)
with intravenous colistin: a comparison
with imipenem-susceptible VAP. Clin Infect
Dis Off Publ Infect Dis Soc Am. 1 de
mayo de 2003;36(9):1111-8.
Betrosian AP, Frantzeskaki F, Xanthaki
A, Douzinas EE. Efficacy and safety of
high-dose ampicillin/sulbactam vs. colistin
as monotherapy for the treatment of
multidrug resistant Acinetobacter baumannii
ventilator-associated pneumonia.
J Infect. junio de 2008;56(6):432-6.
Bialvaei AZ, Samadi Kafil H. Colistin,
mechanisms and prevalence of resistance.
Curr Med Res Opin. 20 de febrero
de 2015;31(4):707-21.
Justo JA, Bosso JA. Adverse reactions
associated with systemic polymyxin
therapy. Pharmacother J Hum Pharmacol
Drug Ther. 1 de enero de 2015;35(1):28-
Giacometti A, Cirioni O, Ghiselli R, Orlando
F, Mocchegiani F, D’amato G, et
al. Antiendotoxin Activity of Antimicrobial
Peptides and Glycopeptides. J Chemother.
de enero de 2003;15(2):129-33.
Petrosillo N, Giannella M, Antonelli M,
Antonini M, Barsic B, Belancic L, et al.
Clinical experience of colistin-glycopeptide
combination in critically ill patients
infected with gram-negative bacteria.
Antimicrob Agents Chemother. 1 de febrero
de 2014;58(2):851-8.
Karaiskos I, Giamarellou H. Multidrug-
resistant and extensively drug-resistant
Gram-negative pathogens: current
and emerging therapeutic approaches.
Expert Opin Pharmacother. 28 de abril de
;15(10):1351-70.
Owen RJ, Li J, Nation RL, Spelman D.
In vitro pharmacodynamics of colistin
against Acinetobacter baumannii clinical
isolates. J Antimicrob Chemother. 1 de
marzo de 2007;59(3):473-7.
Kassamali Z, Jain R, Danziger LH. An
Update on the arsenal for multidrug-resistant
Acinetobacter infections: Polymyxin
antibiotics. Int J Infect Dis. 1 de enero de
;30:125-32.
Paul M, Bishara J, Levcovich A, Chowers
M, Goldberg E, Singer P, et al.
Effectiveness and safety of colistin:
prospective comparative cohort study.
J Antimicrob Chemother. 1 de mayo de
;65(5):1019-27.
Durante-Mangoni E, Signoriello G, Andini
R, Mattei A, Cristoforo MD, Murino
P, et al. Colistin and rifampicin compared
with colistin alone for the treatment of
serious infections due to extensively
drug-resistant Acinetobacter baumannii:
A multicenter, randomized clinical
trial. Clin Infect Dis. 1 de agosto de
;57(3):349-58.
Aydemir H, Akduman D, Piskin N, Comert
F, Horuz E, Terzi A, et al. Colistin vs.
the combination of colistin and rifampicin
for the treatment of carbapenem-resistant
Acinetobacter baumannii ventilator-associated
pneumonia. Epidemiol Infect. junio
de 2013;141(06):1214-22.
Montravers P, Dupont H, Bedos J-P, Bret
P, Tigecycline Group. Tigecycline use in
critically ill patients: a multicentre prospective
observational study in the intensive
care setting. Intensive Care Med.
julio de 2014;40(7):988-97.
Manchanda V, Sanchaita S, Singh N.
Multidrug resistant Acinetobacter. J Glob
Infect Dis. 2010;2(3):291-304.
Curcio DJ, Istúriz RE. Tigeciclina, la primera
glicilciclina. Rev Panam Infectol
[internet]. septiembre de 2006;8(3):35-
Disponible en: http://www.sld.cu/
galerias/pdf/sitios/apua-cuba/tigeciclina,_
la_primera_glicilglicina.pdf
Kwon SH, Ahn HL, Han OY, La HO. Efficacy
and safety profile comparison of
colistin and tigecycline on the extensively drug resistant Acinetobacter baumannii.
Biol Pharm Bull. 2014;37(3):340-6.
Bazan JA, Martin SI, Kaye KM. Newer
Beta-lactam Antibiotics: Doripenem,
ceftobiprole, ceftaroline, and cefepime.
Antibact Ther Newer Agents. julio de
;95(4):743-60.
Queenan AM, Shang W, Flamm R, Bush
K. Hydrolysis and inhibition profiles of
β-lactamases from molecular classes A to
D with doripenem, imipenem, and meropenem.
Antimicrob Agents Chemother.
enero de 2010;54(1):565-9.
Pankuch GA, Seifert H, Appelbaum PC.
Activity of doripenem with and without
levofloxacin, amikacin, and colistin
against Pseudomonas aeruginosa and
Acinetobacter baumannii. Diagn Microbiol
Infect Dis. junio de 2010;67(2):191-7.
Clock SA, Tabibi S, Alba L, Kubin CJ,
Whittier S, Saiman L. In vitro activity
of doripenem alone and in multi-agent
combinations against extensively drug-resistant
Acinetobacter baumannii and
Klebsiella pneumoniae. Diagn Microbiol
Infect Dis. 1 de julio de 2013;76(3):343-6.
Marti S, Sánchez-Céspedes J, Alba V,
Vila J. In vitro activity of doripenem
against Acinetobacter baumannii clinical
isolates. Int J Antimicrob Agents. febrero
de 2009;33(2):181-2.
Pankuch GA, Seifert H, Appelbaum PC.
Activity of doripenem with and without
levofloxacin, amikacin, and colistin
against Pseudomonas aeruginosa and
Acinetobacter baumannii. Diagn Microbiol
Infect Dis. junio de 2010;67(2):191-7.
Housman ST, Hagihara M, Nicolau DP,
Kuti JL. In vitro pharmacodynamics of
human-simulated exposures of ampicillin/
sulbactam, doripenem and tigecycline
alone and in combination against multidrug-
resistant Acinetobacter baumannii.
J Antimicrob Chemother. 1 de octubre de
;68(10):2296-304.
Walther-Rasmussen J, Høiby N. OXAtype
carbapenemases. J Antimicrob Chemother.
de marzo de 2006;57(3):373-83.
Akova M. Sulbactam-containing
β-lactamase inhibitor combinations. Clin
Microbiol Infect. enero de 2008;14(Suppl
:185-8.
Lin C, Su S, Ho K, Hsu Y, Lee K. Bactericidal
effect of sulbactam against
Acinetobacter baumannii ATCC 19606
studied by 2D-DIGE and mass spectrometry.
Int J Antimicrob Agents. julio de
;44(1):38-46.
Chu H, Zhao L, Wang M, Liu Y, Gui T,
Zhang J. Sulbactam-based therapy for
Acinetobacter baumannii infection: a
systematic review and meta-analysis.
Braz J Infect Dis Off Publ Braz Soc Infect
Dis. agosto de 2013;17(4):389-94.
Yokoyama Y, Matsumoto K, Ikawa K,
Watanabe E, Shigemi A, Umezaki Y,
et al. Pharmacokinetic/pharmacodynamic
evaluation of sulbactam against
Acinetobacter baumannii in in vitro and
murine thigh and lung infection models.
Int J Antimicrob Agents. junio de
;43(6):547-52.
Xia J, Zhang D, Xu Y, Gong M, Zhou Y,
Fang X. A retrospective analysis of carbapenem-
resistant Acinetobacter baumannii-
mediated nosocomial pneumonia
and the in vitro therapeutic benefit of
cefoperazone/sulbactam. Int J Infect Dis.
junio de 2014;23(0):90-3.
Kiratisin P, Apisarnthanarak A, Kaewdaeng
S. Synergistic activities between
carbapenems and other antimicrobial
agents against Acinetobacter baumannii
including multidrug-resistant and extensively drug-resistant isolates. Int
J Antimicrob Agents. septiembre de
;36(3):243-6.
Ozbek B, Sentürk A. Postantibiotic effects
of tigecycline, colistin sulfate, and
levofloxacin alone or tigecycline-colistin
sulfate and tigecycline-levofloxacin combinations
against Acinetobacter baumannii.
Chemotherapy. 2010;56(6):466-71.
Cai Y, Chai D, Wang R, Liang B, Bai
N. Colistin resistance of Acinetobacter
baumannii: clinical reports, mechanisms
and antimicrobial strategies. J
Antimicrob Chemother. 1 de julio de
;67(7):1607-15.
Li J, Rayner CR, Nation RL, Owen RJ,
Spelman D, Tan KE, et al. Heteroresistance
to colistin in multidrug-resistant
Acinetobacter baumannii. Antimicrob
Agents Chemother. 1 de septiembre de
;50(9):2946-50.
Rahal JJ. Novel antibiotic combinations
against infections with almost completely
resistant Pseudomonas aeruginosa and
Acinetobacter species. Clin Infect Dis. 1
de septiembre de 2006;43(Suppl 2):S95-
Dong X, Chen F, Zhang Y, Liu H, Liu
Y, Ma L. In vitro activities of rifampin,
colistin, sulbactam and tigecycline tested
alone and in combination against extensively
drug-resistant Acinetobacter baumannii.
J Antibiot (Tokyo). septiembre
de 2014;67(9):677-80.
Teo J, Lim T-P, Hsu L-Y, Tan T-Y, Sasikala
S, Hon P-Y, et al. Extensively drug-resistant
Acinetobacter baumannii in a
Thai hospital: a molecular epidemiologic
analysis and identification of bactericidal
Polymyxin B-based combinations. Antimicrob
Resist Infect Control [Internet].
de enero de 2015 [citado 20 de abril
de 2015];4(1). Disponible en: http://
www.ncbi.nlm.nih.gov/pmc/articles/
PMC4314787/
Abbott I, Cerqueira GM, Bhuiyan S, Peleg
AY. Carbapenem resistance in Acinetobacter
baumannii: laboratory challenges,
mechanistic insights and therapeutic strategies.
Expert Rev Anti Infect Ther. 1 de
abril de 2013;11(4):395-409.
This journal is registered under a Creative Commons Attribution 4.0 International Public License. Thus, this work may be reproduced, distributed, and publicly shared in digital format, as long as the names of the authors and Pontificia Universidad Javeriana are acknowledged. Others are allowed to quote, adapt, transform, auto-archive, republish, and create based on this material, for any purpose (even commercial ones), provided the authorship is duly acknowledged, a link to the original work is provided, and it is specified if changes have been made. Pontificia Universidad Javeriana does not hold the rights of published works and the authors are solely responsible for the contents of their works; they keep the moral, intellectual, privacy, and publicity rights.
Approving the intervention of the work (review, copy-editing, translation, layout) and the following outreach, are granted through an use license and not through an assignment of rights. This means the journal and Pontificia Universidad Javeriana cannot be held responsible for any ethical malpractice by the authors. As a consequence of the protection granted by the use license, the journal is not required to publish recantations or modify information already published, unless the errata stems from the editorial management process. Publishing contents in this journal does not generate royalties for contributors.