Información del artículo
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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Bibliografía
[1.]
E. Bergogne-Berezin, K.J. Towner.
Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features.
Clin Microbiol Rev, 9 (1996), pp. 148-165
[2.]
D.M. Allen, B.J. Hartman.
Acinetobacter species.
Principles and practices of infectious diseases, pp. 2632-2636
[3.]
J. Rodríguez-Baño, J.M. Cisneros, F. Fernández Cuenca, A. Ribera, J. Vila, A. Pascual, et al.
Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in spanish hospital.
Infect Control Hosp Epidemiol, 25 (2004), pp. 819-824
[4.]
C. Urban, E. Go, N. Mariano, B.J. Berger, I. Avraham, D. Rubin, et al.
Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus.
J Infect Dis, 167 (1993), pp. 448-451
[5.]
P.R. Hsueh, L.J. Teng, C.Y. Chen, W.H. Chen, C.J. Yu, S.W. Ho, et al.
Pandrug-resistant Acinetobacter baumannii causing nosocomial infections in a university hospital, Taiwan.
Emerging Infect Dis, 8 (2002), pp. 827-832
[6.]
F. Fernández, A. Pascual, A. Ribera, A. Vila, G. Bou, J.M. Cisneros, et al.
Diversidad clonal y sensibilidad a los antimicrobianos de Acinetobacter baumannii aislados en hospitales españoles. Estudio multicéntrico nacional: proyecto GEIH-Ab 2000.
Enferm Infecc Microbiol Clin, 22 (2004), pp. 267-271
[7.]
H. Wisplinghoff, M.B. Edmond, M.A. Pfaller, R.N. Jones, R. Wenzel, H. Seifert.
Nosocomial bloodstream infections caused by Acinetobacter species in United States Hospitals: Clinical features, molecular epidemiology, and antimicrobial susceptibility.
Clin Infect Dis, 31 (2000), pp. 690-697
[8.]
Cisneros JM, Rodríguez-Baño J, Fernández-Cuenca F, Ribera A, Vila J, Pascual A, et al. Risk factors for the acquisition of imipenem-resistant Acinetobacter baumannii in Spain. A nationwide study. [En prensa]. Clin Microbiol Infect. 2005.
[9.]
S.O. Lee, N.J. Kim, S.H. Choi, T. Hyong Kim, J.W. Chung, J.H. Woo, et al.
Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case-control study.
Antimicrob. Agents Chemother, 48 (2004), pp. 224-228
[10.]
L. Fierobe, J.C. Lucet, D. Decré, C. Muller-Serieys, A. Deleuze, M.L. Joly-Guillou, et al.
An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients.
Infect Control Hosp Epidemiol, 22 (2001), pp. 35-40
[11.]
V.M. Manikal, D. Landman, G. Saurina, E. Oydna, H. Lal, J. Quale.
Endemic carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage.
Clin Infect Dis, 31 (2000), pp. 101-106
[12.]
H.M. Richet, J. Mohammed, L.C. McDonald, W.R. Jarvis.
Building communication networks: international network for the study of emerging antimicrobial resistence.
Emerging Infect Dis, 7 (2001), pp. 319-322
[13.]
L.A. Arroyo, A. Garcia-Curiel, M.E. Pachón-Ibáñez, A.C. Llanos, M. Ruiz, J. Pachón, et al.
Reliability of the E-test method for detection of colistin resistance in clinical isolates of Acinetobacter baumannii.
J Clin Microbiol, 43 (2005), pp. 903-905
[14.]
J. Rello, M. Sa-Borges, H. Correa, S.R. Leal, J. Baraibar.
Variations in etiology of ventilator-associated pneumonia across four treatment sites.
Am J Resp Crit Care Med, 160 (1999), pp. 608-613
[15.]
J.L. Troullet, J. Chastre, A. Vaugnat, L. Joly-Guillou, D. Cambaux, C. Dombert, et al.
Ventilator-associated pneumonia caused by potentially drug-resistant bacteria.
Am J Resp Crit Care Med, 157 (1998), pp. 531-539
[16.]
R.C. Spencer.
Predominant pathogens found in the European Prevalence of Infection in Intensive Care Study.
Eur J Clin Microbiol Infect Dis, 15 (1996), pp. 281-285
[17.]
F. Álvarez-Lerma, M. Palomar-Martínez, P. Olaechea-Astigarraga, J. Insausti-Ordeñana, B. Bermejo-Fraile, E. Cerdá-Cerdá.
Estudio nacional de vigilancia de infección nosocomial en Unidades de Cuidados Intensivos. Informe del año 2002.
Med Intensiva, 29 (2005), pp. 1-12
[18.]
J. Garnacho-Montero, C. Ortiz-Leyba, E. Fernandez-Hinojosa, T. Aldabo-Pallas, A. Cayuela, J.A. Marquez-Vacaro, et al.
Acinetobacter baumannii ventilator-associated pneumonia: epidemiological and clinical findings.
Intensive Care Med, 31 (2005), pp. 649-655
[19.]
J. Baraibar, H. Correa, D. Mariscal, M. Gallego, J. Valles, J. Rello.
Risk factors for infection by A. baumannii in intubated patients with pneumonia.
Chest, 112 (1997), pp. 1050-1054
[20.]
R.N. Husni, L.S. Goldstein, A.C. Arroliga, A.C. Arroliga, G.S. Hall, C. Fatica, et al.
Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients.
Chest, 115 (1999), pp. 1378-1382
[21.]
J. Garnacho-Montero, J. Sole-Violan, M. Sa-Borges, E. Diaz-Santos, J. Rello.
Clinical impact of pneumonia caused by A. baumannii in intubated patients: A matched cohort study.
Crit Care Med, 31 (2003), pp. 2478-2482
[22.]
X. Corbella, M. Pujol, J. Ayats, M. Sendra, C. Ardanuy, M.A. Dominguez, et al.
Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant A. baumannii.
Clin Infect Dis, 23 (1996), pp. 329-334
[23.]
J.L. García Garmendia, C. Ortiz Leyba, J. Garnacho-Montero, F.J. Jiménez Jiménez, C. Pérez-Paredes, A.E. Barrero-Almodóvar, et al.
Risk factors for A. baumannii nosocomial bacteremia in critically ill patients: A cohort study.
Clin Infect Dis, 33 (2001), pp. 939-946
[24.]
J.M. Cisneros, M.J. Reyes, J. Pachón, B. Becerril, F.J. Caballero, J.L. García-Garmendía, et al.
Bacteremia due to Acinetobacter baumannii: epidemiology, clinical and prognostic features.
Clin Infect Dis, 22 (1996), pp. 1026-1032
[25.]
R.N. Husni, L.S. Goldstein, A.C. Arroliga, A.C. Arroliga, G.S. Hall, C. Fatica, et al.
Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients.
Chest, 115 (1999), pp. 1378-1382
[26.]
J.L. Garcia-Garmendia, C. Ortiz-Leyba, J. Garnacho-Montero, F.J. Jimenez-Jimenez, J. Monterrubio-Villar, M. Gili-Miner.
Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients.
Crit Care Med, 27 (1999), pp. 1794-1799
[27.]
J.Y. Fagon, J. Chastre, Y. Domart, J.L. Trouillet, C. Gibert.
Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a protected specimen brush.
Clin Infect Dis, 23 (1996), pp. 538-542
[28.]
J. Rello, P. Jubert, J. Vallés, A. Artigas, M. Rue, M.S. Niederman.
Evaluation of outcome in intubated patients with pneumonia caused by Pseudomonas aeruginosa.
Clin Infect Dis, 23 (1996), pp. 973-978
[29.]
Rello J, Sole-Violan J, Sa-Borges M, Garnacho-Montero J, Muñoz E, Sirgo G, et al. Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides. [En prensa]. Crit Care Med. 2005.
[30.]
J.Y. Fagon, J. Chastre, A.J. Hance, P. Montravers, A. Novara, C. Gibert.
Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay.
Am J Med, 94 (1993), pp. 281-288
[31.]
J. Jordá, A. Torres, F.J. Ariza, F. Alvarez, F. Barcenilla.
Recomendaciones para el tratamiento de la neumonía intrahospitalaria grave. Documento de Consenso.
Enferm Infecc Microbiol Clin, 22 (2004), pp. 471-485
[32.]
M.L. Joly-Guillou, M. Wolf, J.J. Pocidalo, F. Walker, C. Carbon.
Use of a new mouse model of A. baumannii pneumonia to evaluate the postantibiotic effect of imipenem.
Antimicrob Agents Chemother, 41 (1997), pp. 345-351
[33.]
J. Garnacho-Montero, C. Ortiz-Leyba, F.J. Jimenez-Jimenez, A.E. Barrero-Almodovar, J.L. Garcia-Garmendia, M. Bernabeu-WittelI, et al.
Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP.
Clin Infect Dis, 36 (2003), pp. 1111-1118
[34.]
G.C. Wood, S.D. Hanes, M.A. Croce, T.C. Fabian, B.A. Boucher.
Comparison of ampicillin-sulbactam and imipenem-cilastatin for the treatment of Acinetobacter ventilator-associated pneumonia.
Clin Infect Dis, 34 (2002), pp. 1425-1430
[35.]
M.J. Rodríguez-Hernández, L. Cuberos, C. Pichardo, F.J. Caballero, I. Moreno, M.E.J. Jimenez-Mejias, et al.
Sulbactam efficacy in experimental models caused by susceptible and intermediate Acinetobacter baumannii strains.
J Antimicrob Chemother, 47 (2001), pp. 479-482
[36.]
A.S. Levin, C.E. Levy, A.E. Manrique, E.A. Medeiros, S.F. Costa.
Severe nosocomial infections with imipenem-resistant Acinetobacter baumannii treated with ampicillin/sulbactam.
Int J Antimicrob Agents, 21 (2003), pp. 58-62
[37.]
J. Brauers, U. Frank, M. Kresken, A.C. Rodloff, H. Seifert.
Activities of various beta-lactams and beta-lactam/beta-lactamase inhibitor combinations against Acinetobacter baumannii and Acinetobacter DNA group 3 strains.
Clin Microbiol Infect, 11 (2005), pp. 24-30
[38.]
J.M. Cisneros, J. Rodríguez-Baño.
Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment.
Clin Microbiol Infect, 8 (2002), pp. 687-693
[39.]
M.J. Rodríguez-Hernández, J. Pachón, C. Pichardo, L. Cuberos, J. Ibáñez-Martínez, A. García-Curiel, et al.
Imipenem, doxycycline and amikacin in monotherapy and in combination in Acinetobacter baumannii experimental pneumonia.
J Antimicrob Chemother, 45 (2000), pp. 493-501
[40.]
M. Bernabeu-Wittel, C. Pichardo, A. Garcia-Curiel, M.E. Pachón-Ibáñez, J. Ibáñez-Martínez, M.E. Jimenez-Mejias, et al.
Pharmacokinetic/pharmacodynamic assessment of the in-vivo efficacy of imipenem alone or in combination with amikacin for the treatment of experimental multiresistant Acinetobacter baumannii pneumonia.
Clin Microbiol Infect, 11 (2005), pp. 319-325
[41.]
A. Montero, J. Ariza, X. Corbella, A. Domenech, C. Cabellos, J. Ayats, et al.
Antibiotic combinations for serious infections caused by carbapenem-resistant Acinetobacter baumannii in a mouse pneumonia model.
J Antimicrob Chemother, 54 (2004), pp. 1085-1091
[42.]
M.J. Rodríguez-Hernández, M.E. Jimenez-Mejias, C. Pichardo, L. Cuberos, A. García-Curiel, J. Pachón.
Colistin efficacy in an experimental model of Acinetobacter baumannii endocarditis.
Clin Microbiol Infect, 10 (2004), pp. 581-584
[43.]
M.E. Pachón-Ibáñez.
Tratamiento de la neumonía experimental por Acinetobacter baumannii multirresistente y panresistente. Estudios de sinergia con carbapenemes, sulbactam, rifampicina y colistina in vitro e in vivo [tesis doctoral.
Universidad de Sevilla, (2005),
[44.]
A. Montero, J. Ariza, X. Corbella, A. Doménech, C. Cabellos, J. Ayats, et al.
Efficacy of colistin versus beta-lactams, aminoglucosides, and rifampin as monotherapy in a mouse model of pneumonia caused by multiresistant A. baumannii.
Antimicrob Agents Chemother, 46 (2002), pp. 1946-1952
[45.]
A.S. Levin, A.A. Barone, Penço, M.V. Santos, I.S. Marinho, E.A. Arruda, et al.
Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii.
Clin Infect Dis, 28 (1999), pp. 1008-1011
[46.]
R. Reina, E. Estenssoro, G. Saenz, H.S. Canales, R. Gonzalvo, G. Vidal, et al.
Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study.
Intensive Care Med, 31 (2005), pp. 1058-1065
[47.]
M.J. Rodríguez-Hernández, J. Pachón, C. Pichardo, L. Cuberos, J. Ibáñez-Martínez, A. Garcia-Curiel, et al.
Imipenem, doxycycline and amikacin in monotherapy and in combination in Acinetobacter baumannii experimental pneumonia.
J Antimicrob Chemother, 45 (2000), pp. 493-501
[48.]
G.C. Wood, S.D. Hanes, B.A. Boucher, M.A. Croce, T.C. Fabian.
Tetracyclines for treating multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia.
Intensive Care Med, 29 (2003), pp. 2072-2076
[49.]
C.M. Lee, H.K. Lim, C.P. Liu, H.K. Tseng.
Treatment of pan-drug resistant Acinetobacter baumannii.
Scand J Infect Dis, 37 (2005), pp. 195-199
[50.]
J.Y. Choi, Y.S. Park, C.H. Cho, Y.S. Park, S.Y. Shin, Y.G. Song, et al.
Synergic in-vitro activity of imipenem and sulbactam against Acinetobacter baumannii.
Clin Microbiol Infect, 10 (2004), pp. 1098-1101
[51.]
W.C. Ko, H.C. Lee, S.R. Chiang, J.J. Yan, J.J. Wu, C.L. Lu, et al.
In vitro and in vivo activity of meropenem and sulbactam against a multidrug-resistant Acinetobacter baumannii strain.
J Antimicrob Chemother, 53 (2004), pp. 393-395
[52.]
M.E. Pachón-Ibánez, M.E. Jimenez-Mejias, C. Pichardo, A.C. Llanos, J. Pachón.
Activity of tigecycline (GAR-936) against Acinetobacter baumannii strains, including those resistant to imipenem.
Antimicrob Agents Chemother, 48 (2004), pp. 4479-4481
[53.]
L. Dijkshoorn, C.P. Brouwer, S.J. Bogaards, A. Nemec, P.J. Van den Broek, P.H. Nibbering.
The synthetic N-terminal peptide of human lactoferrin, hLF(1-11), is highly effective against experimental infection caused by multidrug-resistant Acinetobacter baumannii.
Antimicrob Agents Chemother, 48 (2004), pp. 4919-4921
[54.]
J.M. Cisneros, J. Pachón.
Acinetobacter baumannii: un patógeno nosocomial de difícil control.
Enferm Infecc Microbiol Clin, 21 (2003), pp. 221-223
[55.]
J.D. Pimentel, J. Low, K. Styles, O.C. Harris, A. Hughes, E. Athan.
Control of an outbreak of multi-drug-resistant Acinetobacter baumannii in an intensive care unit and a surgical ward.
J Hosp Infect, 59 (2005), pp. 249-253
[56.]
C. Urban, S. Segal-Maurer, J.J. Rahal.
Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii.
Clin Infect Dis, 15 (2003), pp. 1268-1274
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