Editing Acinetobacter (section)

== Treatment ==
''Acinetobacter'' species are innately resistant to many classes of antibiotics, including [[penicillin]], [[chloramphenicol]], and often [[aminoglycoside]]s. Resistance to [[fluoroquinolones]] has been reported during therapy, which has also resulted in increased resistance to other drug classes mediated through active drug [[efflux (microbiology)|efflux]]. A dramatic increase in [[antibiotic resistance]] in ''Acinetobacter'' strains has been reported by the [[Centers for Disease Control and Prevention]] (CDC), and the carbapenems are recognised as the gold-standard and treatment of last resort.<ref name=Rahal_2006>{{cite journal | author = Rahal J | title = Novel antibiotic combinations against infections with almost completely resistant ''Pseudomonas aeruginosa'' and ''Acinetobacter'' species | journal = Clin Infect Dis | volume = 43 | pages = S95–9 | year = 2006 | issue = Suppl 2 | pmid = 16894522 | doi = 10.1086/504486| doi-access = free }}</ref> ''Acinetobacter'' species are unusual in that they are sensitive to [[sulbactam]], which is commonly used to inhibit bacterial beta-lactamase, but this is an example of the antibacterial property of sulbactam itself.<ref name="Wood2002">{{cite journal |vauthors=Wood GC, Hanes SD, Croce MA, Fabian TC, Bougher BA | title=Comparison of ampicillin-sulbactam and imipenem-cilastatin for the treatment of ''Acinetobacter'' ventilator-associated pneumonia | journal=Clin Infect Dis | year=2002 | volume=34 | pages=1425–30  | doi=10.1086/340055 | pmid=12015687 | issue=11| doi-access=free }}</ref> Recently sulbactam-durlobactam, a new antibacterial combination undergoing phase 3 trial, has demonstrated good ''in vitro'' activity also against carbapenem-resistant ''A. baumannii'' isolates (92% susceptibility).<ref>{{Cite journal |last1=Segatore |first1=Bernardetta |last2=Piccirilli |first2=Alessandra |last3=Cherubini |first3=Sabrina |last4=Principe |first4=Luigi |last5=Alloggia |first5=Giovanni |last6=Mezzatesta |first6=Maria Lina |last7=Salmeri |first7=Mario |last8=Di Bella |first8=Stefano |last9=Migliavacca |first9=Roberta |last10=Piazza |first10=Aurora |last11=Meroni |first11=Elisa |last12=Fazii |first12=Paolo |last13=Visaggio |first13=Daniela |last14=Visca |first14=Paolo |last15=Cortazzo |first15=Venere |date=2022-08-22 |title=In Vitro Activity of Sulbactam–Durlobactam against Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates: A Multicentre Report from Italy |journal=Antibiotics |language=en |volume=11 |issue=8 |pages=1136 |doi=10.3390/antibiotics11081136 |pmid=36010006 |pmc=9404735 |issn=2079-6382|doi-access=free }}</ref>

In November 2004, the CDC reported an increasing number of ''A. baumannii'' bloodstream infections in patients at military medical facilities in which service members injured in the [[Iraq]]/[[Kuwait]] region during [[Operation Iraqi Freedom]] and in [[Afghanistan]] during [[Operation Enduring Freedom]] were treated.<ref name=MMWR_2004>{{cite journal | title = ''Acinetobacter baumannii'' infections among patients at military medical facilities treating injured U.S. service members, 2002-2004 | journal = MMWR Morb Mortal Wkly Rep | volume = 53 | issue = 45 | pages = 1063–6 | year = 2004|pmid = 15549020 | author1 = Centers for Disease Control and Prevention}}</ref> Most of these were multidrug-resistant. Among one set of isolates from [[Walter Reed Army Medical Center]], 13 (35%) were susceptible to [[imipenem]] only, and two (4%) were resistant to all drugs tested. One antimicrobial agent, [[colistin]] (polymyxin E), has been used to treat infections with multidrug-resistant ''A. baumannii''; however, antimicrobial susceptibility testing for colistin was not performed on isolates described in this report. Because ''A. baumannii'' can survive on dry surfaces up to 20 days, they pose a high risk of spread and contamination in hospitals, potentially putting immunocompromised and other patients at risk for drug-resistant infections that are often fatal and, in general, expensive to treat. Trials to implement vaccines to prevent Acinetobacter infections were documented.<ref name="Ahmad2016">{{cite journal |vauthors=Ahmad TA, Tawfik DM, Sheweita SA, Haroun M, El-Sayed LH| title=Development of immunization trials against Acinetobacter baumannii| journal=Trials in Vaccinology| year=2016 | volume=5 | pages=53–60 | doi=10.1016/j.trivac.2016.03.001| doi-access=free}}</ref><ref name="Tawfik2017">{{cite journal |vauthors=Tawfik DM, AhmadTA, Sheweita SA, Haroun M, El-Sayed LH| title=The detection of antigenic determinants of Acinetobacter baumannii| journal=Immunology Letters| year=2017 | volume=186 | pages=59–67 | doi=10.1016/j.imlet.2017.04.004| pmid=28427887|url=https://www.sciencedirect.com/science/article/pii/S0165247817300901| url-access=subscription}}</ref>

Reports suggest this bacterium is susceptible to [[phage therapy]].<ref name="Matsuzaki2005">{{cite journal |vauthors=Matsuzaki S, Rashel M, Uchiyama J |title=Bacteriophage therapy: a revitalized therapy against bacterial infectious diseases |journal=J. Infect. Chemother. |volume=11 |issue=5 |pages=211–9 |date=October 2005 |pmid=16258815 |doi=10.1007/s10156-005-0408-9 |s2cid=8107934 |display-authors=etal}}</ref>

Gene-silencing antisense oligomers in a form called peptide-conjugated phosphorodiamidate [[morpholino]] oligomers have also been reported to inhibit growth in tests carried out in animals infected with antibiotic-resistant ''A. baumannii''.<ref name="Geller 2013">{{cite journal |vauthors=Geller BL, Marshall-Batty K, Schnell FJ |title=Gene-Silencing Antisense Oligomers Inhibit Acinetobacter Growth In Vitro and In Vivo. J. Infect. Diseases |date=October 2013|display-authors=etal}}</ref><ref name="OSU News">{{cite web |url=http://oregonstate.edu/ua/ncs/archives/2013/oct/beyond-antibiotics-%E2%80%9Cppmos%E2%80%9D-offer-new-approach-bacterial-infection |title=Beyond antibiotics: PPMOs offer new approach to bacterial infection |date=2013-10-15 |access-date=October 15, 2013 }}</ref>

[[Sulbactam/durlobactam]] (Xacduro) was approved for medical use in the United States in May 2023.<ref name="FDA PR 20230523">{{cite press release | title=FDA Approves New Treatment for Pneumonia Caused by Certain Difficult-to-Treat Bacteria | website=U.S. Food and Drug Administration | date=24 May 2023 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-pneumonia-caused-certain-difficult-treat-bacteria | archive-url=https://web.archive.org/web/20230523231227/https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-pneumonia-caused-certain-difficult-treat-bacteria | url-status=dead | archive-date=May 23, 2023 | access-date=24 May 2023}} {{PD-notice}}</ref>