# Integrative review on Acinetobacter baumannii as a multidrug-resistant pathogen: resistance mechanisms and therapeutic perspectives in the context of nosocomial infections

## TL;DR

This paper reviews Acinetobacter baumannii's resistance mechanisms and new treatments for hospital-acquired infections.

## Contribution

The paper provides an updated overview of resistance mechanisms and emerging therapies for MDR A. baumannii.

## Key findings

- MDR in A. baumannii is driven by efflux pumps, enzyme production, and structural modifications.
- New drugs like cefiderocol and combinations with colistin show promise against MDR A. baumannii.
- Current treatment options remain limited, highlighting the need for novel therapeutic strategies.

## Abstract

Acinetobacter baumannii is a gram-negative opportunistic pathogen associated with high morbidity and mortality in nosocomial infections, particularly in intensive care units. Multidrug resistance (MDR) is mediated by efflux pumps, lipopolysaccharide modifications, aminoglycoside adenylyltransferases, FosA, structural alterations, and production of enzymes that inactivate antibiotics, such as carbapenemases. These factors limit the therapeutic options and increase clinical challenges, as there are currently few drugs or combinations with therapeutic success against A. baumannii infections. Some strategies and new drugs, such as cefiderocol, eravacycline, sulbactam-darlobactam, tigecycline, and their combinations with colistin, are being tested and have shown apparent advances. This integrative review discusses the current resistance mechanisms and emerging therapeutic strategies aimed at overcoming the growing threat posed by MDR A. baumannii.