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J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-3479
10.4103/jfmpc.jfmpc_609_24
Letter to Editor
What is best choice for battle with multi drug resistant Acinetobacter? Newer antibiotics or prevention?
Mukhida Sahjid 1
Kannuri Sriram 2
1 Department of Microbiology, GMERS Medical College, Junagadh, Gujarat, India
2 Department of Microbiology, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India
Address for correspondence: Dr. Sriram Kannuri, Department of Microbiology, NRI Institute of Medical Sciences, Visakhapatnam - 531 163, Andhra Pradesh, India. E-mail: dr.sriram.microbiology@nriims.com
8 2024
26 7 2024
13 8 34793480
11 4 2024
15 5 2024
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcDear Editor,

Recently, we have gone through the article published in your esteemed journal. The author very briefly described the seriousness of infection caused by Acinetobacter baumanni complex organism and their current situation in antimicrobial resistance.[1] As our experience with Acinetobacter species.

The COVID-19 pandemic, which affected the entire globe between 2020 and 2023, continues to have residual impacts due to the emergence of new variants.[2] However, an equally significant but less recognized threat has been developing over the past few decades: the rise of antibiotic-resistant bacteria. The fight against bacteria began with Alexander Fleming’s discovery of penicillin, the first antibiotic.[3] As new antibiotics were discovered, bacteria began to mutate to survive, leading to the emergence of ESKAPE (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter species, Pseudomonas aeruginosa, and Enterobacter species) pathogens.[1] These pathogens are commonly found in healthcare environments and can cause opportunistic infections in hospitalized patients. Most of these hospital-acquired pathogens are multidrug-resistant, with only a limited number of antibiotics effective against them. While these pathogens can also be community-acquired, these strains are typically less resistant.

Hospital-acquired ESKAPE pathogens, particularly Acinetobacter baumannii complex and Pseudomonas aeruginosa, are non-fermenters, making their treatment more challenging when they are multidrug-resistant (MDR). The situation becomes even more complex when a patient is co-infected with both non-fermenters, leaving only one or two drugs for treatment due to intrinsic resistance.[4] Hospital-acquired MDR Acinetobacter baumannii complex is resistant to cephalosporins, fluoroquinolones, beta-lactam (BL) + BL Inhibiter combinations, aminoglycosides, and/or carbapenems. It is intrinsically resistant to aminopenicillin, amoxicillin/clavulanic acid, nitrofurantoin, fosfomycin, aztreonam, and chloramphenicol.[5] The only remaining treatment options are polymyxins (colistin and polymyxin B) and tigecycline, with or without amikacin. Without a combination of higher antibiotics, the chances of successfully treating an MDR Acinetobacter infection are slim. The newer colistin-sparing combination of ceftazidime and avibactam, along with the aztreonam synergy effect, is used for carbapenem-resistant bacterial infections, though it is ineffective against Acinetobacter species due to intrinsic resistance.[5]

So, how should patients be treated? In most cases, these are hospital-acquired infections, often resulting from contamination or colonization of Acinetobacter species on medical devices. If the source is removed, the infection is usually self-limiting. If the patient is moved away from the hospital environment, the infection will subside. According to various infection control practices, prevention is the best strategy when effective treatment is not available. Proper hand hygiene and careful handling of devices can reduce the risk of MDR Acinetobacter infection in patients.[6] This should be maintained by patients, their caregivers, and their surroundings to decrease the risk of Acinetobacter infection re-emergence.

So we conclude, the discovery or invention of new antibiotics to treat ESKAPE including MDR Acinetobacter infection is urgently needed; however, until such advancements are made, prevention remains the focal point.

Comments on: Antimicrobial-resistant Acinetobacter: where do we go next?

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
==== Refs
1 Datta A Gandham N Ajagunde J Pawar VD Antimicrobial-resistant Acinetobacter: Where do we go next? J Family Med Prim Care 2024 13 1143 4 38736832
2 Bhaumik S Mukhida S Das NK Khan S Patil R Kannuri S Can vaccine alone bring an end to this pandemic? Natl J Community Med 2023 14 208 9
3 Gaynes R The discovery of penicillin-new insights after more than 75 years of clinical use Emerg Infect Dis 2017 23 849 53
4 Edavaloth P Mukhida S Kannuri S Shah H Datta A Co-existence of two multidrug-resistant non-fermenter gram-negative bacilli: The dead end or is there still hope? Natl J Community Med 2023 14 547 8
5 CLSI. Performance Standards for Antimicrobial Susceptibility Testing 34th ed CLSI Supplement M100. Clinical Laboratory Standard Institute 2024
6 Khan S Mukhida S Patil R Mirza S Ajagunde J Das NK I-, You-, and We-centered approach toward hygienic hands Asia Pac J Public Health 2022 34 879 80 36124374
