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Resumen
Acinetobacter baumannii es una importante causa de neumonía nosocomial, especialmente de las neumonías tardías asociadas a ventilación mecánica. En España, ocupa el tercer lugar en frecuencia tras Pseudomonas aeruginosa y Staphylococcus aureus. Los factores de riesgo para el desarrollo de esta neumonía son el traumatismo craneal, la neurocirugía, el síndrome de distrés respiratorio agudo, la aspiración y el tratamiento antimicrobiano previo.
El diagnóstico de certeza requiere la toma de muestras respiratorias con técnicas invasivas y de cultivos cuantitativos para diferenciar la infección de la frecuente colonización. La mortalidad cruda de los pacientes con neumonía por A. baumannii asociada a ventilación mecánica es elevada, pero la atribución de ésta a la neumonía es controvertida.
El tratamiento antimicrobiano apropiado es un factor pronóstico protector aunque las posibilidades terapéuticas son limitadas. Imipenem es el antimicrobiano de elección y sulbactam el tratamiento alternativo. Colistina es el tratamiento de elección en las neumonías por A. baumannii panresistente. La combinación de rifampicina e imipenem o sulbactam puede ser una alternativa a la colistina en la neumonía por A. baumannii panresistente. Las medidas de control consiguen la erradicación de A. baumannii en los brotes epidémicos, y la reducción del número de casos en las situaciones endémicas. Aunque su aplicación es importante en todo el hospital, las unidades de cuidados intensivos son el lugar clave.
Palabras clave:
Acinetobacter baumannii
Multirresistencia
Panresistencia
Neumonía
Infección nosocomial
Acinetobacter baumannii is a significant cause of nosocomial pneumonia, especially late ventilator-associated pneumonia. In Spain, A. baumannii is the third leading pathogen after Pseudomonas aeruginosa and Staphylococcus aureus. Risk factors for pneumonia due to A. baumannii are head injury, neurosurgery, acute respiratory distress syndrome, aspiration, and previous antibiotic therapy.
Definitive diagnosis requires respiratory samples and invasive techniques with quantitative cultures to differentiate true infections from simple colonizations. The crude mortality of patients with ventilator-associated A. baumannii pneumonia is high, although the attributable mortality is controversial.
Adequate empirical antimicrobial therapy of A. baumannii pneumonia is a protective factor, even though the therapeutic options are often limited. The treatment of choice is imipenem and sulbactam may be considered an acceptable alternative. Nowadays, colistin is the treatment of choice in A. baumannii pneumonia caused by panresistant strains. The associations of imipenem and rifampin or imipenem and sulbactam may be acceptable alternatives to colistin in infections caused by these strains. Surveillance measures are essential to eradicate this multidrug-resistant pathogen in outbreaks and reduce the number of episodes in endemic situations. Although these measures are important throughout the hospital, intensive care units are especially high-risk areas.
Key words:
Acinetobacter baumannii
Multiresistance
Panresistance
Pneumonia
Nosocomial infection
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