# Treating Extensively Drug-Resistant Acinetobacter baumannii: Considerations for Host Characteristics and Type of Infections

## TL;DR

This review discusses the challenges of treating drug-resistant Acinetobacter baumannii infections and highlights factors influencing treatment choices.

## Contribution

The paper provides a comprehensive overview of treatment strategies for drug-resistant A. baumannii, emphasizing patient-specific and infection-specific considerations.

## Key findings

- Mortality from invasive A. baumannii infections exceeds 40%.
- Treatment decisions depend on patient profile, infection site, and resistance patterns.
- Current and emerging antimicrobials are reviewed for their efficacy and pharmacokinetics.

## Abstract

Acinetobacter baumannii has been characterized by CDC, WHO and most National Healthcare Systems worldwide as a critical nosocomial pathogen, and classified as an ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) pathogen. Mortality of invasive infections due to A. baumannii exceeds 40%. To highlight its impact on public health, ECDC has organized a special project on national lab co-ordination to accurately detect and report carbapenem-resistant strains, to identify epidemiological factors for infection (or colonization) with carbapenem-resistant A. baumanii at clonal and sub-genomic level. This review aims to describe the history, epidemiology, and evolution of resistance of A. baumannii, and stress the caveats associated with the management of systemic infections. Available active antimicrobials and drugs in the pipeline are listed, and available clinical evidence on their pharmacokinetics and efficacy in various types of infections are described. Clinician’s choice of treatment (drug, and monotherapy vs. combination treatment) depends on the patients’ profile, site of infection and antimicrobial resistance profile. Emphasis is laid on specific patient subpopulations, whose management is discussed.