Antimicrobial resistance in Acinetobacter baumannii: From bench to bedside

Abstract

Acinetobacter baumannii (A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrug-resistant A. baumannii (MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections.

Keywords: Acinetobacter baumannii, Antibiotic resistance, Epidemiology, Genomics, Infection control

Core tip: With the current rapid increase in the numbers of studies on Acinetobacter baumannii (A. baumannii), the complexity of the entire picture regarding how this superbug copes with its environment and influences human beings is gradually being understood. By conducting a thorough review of this topic, this paper aims to present the relevant literature regarding the antimicrobial resistance of A. baumannii and the currently available treatment options for A. baumannii infections to highlight possible future research directions.