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Intensive Care Medicine

, Volume 41, Issue 12, pp 2057–2075 | Cite as

Task force on management and prevention of Acinetobacter baumannii infections in the ICU

  • José Garnacho-Montero
  • George Dimopoulos
  • Garyphallia Poulakou
  • Murat Akova
  • José Miguel Cisneros
  • Jan De Waele
  • Nicola Petrosillo
  • Harald Seifert
  • Jean François Timsit
  • Jordi Vila
  • Jean-Ralph Zahar
  • Matteo Bassetti
Conference Reports and Expert Panel

Abstract

Introduction

Acinetobacter baumannii constitutes a dreadful problem in many ICUs worldwide. The very limited therapeutic options available for these organisms are a matter of great concern. No specific guidelines exist addressing the prevention and management of A. baumannii infections in the critical care setting.

Methods

Clinical microbiologists, infectious disease specialists and intensive care physicians were invited by the Chair of the Infection Section of the ESICM to participate in a multidisciplinary expert panel. After the selection of clinically relevant questions, this document provides recommendations about the use of microbiological techniques for identification of A. baumannii in clinical laboratories, antibiotic therapy for severe infections and recommendations to control this pathogen in outbreaks and endemic situations. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system.

Results

Empirical coverage of A. baumannii is recommended in severe infections (severe sepsis or septic shock) occurring during an A. baumannii outbreak, in an endemic setting, or in a previously colonized patient. For these cases, a polymyxin is suggested as part of the empirical treatment in cases of a high suspicion of a carbapenem-resistant (CR) A. baumannii strain. An institutional program including staff education, promotion of hand hygiene, strict contact and isolation precautions, environmental cleaning, targeted active surveillance, and antimicrobial stewardship should be instituted and maintained to combat outbreaks and endemic situations.

Conclusions

Specific recommendations about prevention and management of A. baumannii infections in the ICU were elaborated by this multidisciplinary panel. The paucity of randomized controlled trials is noteworthy, so these recommendations are mainly based on observational studies and pharmacodynamics modeling.

Keywords

Acinetobacter baumannii Epidemiology Treatment Colistin Prevention 

Notes

Compliance with ethical standards

Conflicts of interest

JGM serves on scientific advisory board for Pfizer and declares speaker honoraria from Pfizer, Gilead Sciences, Astellas Pharma and MSD. JGM has received scientific unrestricted grants from Astellas Pharma. HS declares financial relationships with Astellas, AstraZeneca, Basilea, Cubist, Durata, FabPharma, Gilead, MSD, Novartis, Pfizer, Roche, Tetraphase, The Medicines Company and Theravance. MA declares travel and speaker honoraria from Merck, Pfizer, Astellas, Gilead Sciences and Cubist. JMC declares has received travels and honoraria as speaker from Astellas Pharma, Novartis, Pfizer, MSD and Astra-Zeneca. JDW declares consultancy for Acelity, AtoxBio, Bayer Healthcare, Cubist, Smith&Nephew, Sumitomo Pharmaceuticals. NP has served on scientific advisory boards for MSD, Pfizer, Cepheid; has received funding for travel or speaker honoraria from MSD, Novartis, Gilead, Pfizer, Zambon, Angelini, Achaogen, Johnson & Johnson. JFT serves on scientific advisory board for Bayer, Merck, 3 M. JFT received scientific unrestricted grants from Merck, Astellas, 3 M, Pfizer. JFT declares travel or speaker honoraria from Merck, Gilead, Astellas, 3 M, Bayer. NP has served on scientific advisory boards for MSD, Pfizer, Cepheid, The Medicines Company; has received funding for travel or speaker honoraria from MSD, Novartis, Gilead, Pfizer, Zambon, Angelini, Achaogen, Johnson & Johnson, Astellas, Carefusion. JRZ declares travels and honoraria as speaker from MSD and Pfizer. MB serves on scientific advisory boards for AstraZeneca, Bayer, Cubist, Pfizer Inc, MSD, Tetraphase and Astellas Pharma Inc, funding for travel or speaker honoraria from Algorithm, Angelini, Astellas Pharma Inc., AstraZeneca, Cubist, Pfizer MSD, Gilead Sciences, Novartis, Ranbaxy, Teva. The other authors have not declared any conflict of interest regarding this manuscript.

Supplementary material

134_2015_4079_MOESM1_ESM.doc (88 kb)
Supplementary material 1 (DOC 87 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • José Garnacho-Montero
    • 1
  • George Dimopoulos
    • 2
  • Garyphallia Poulakou
    • 3
  • Murat Akova
    • 4
  • José Miguel Cisneros
    • 5
  • Jan De Waele
    • 6
  • Nicola Petrosillo
    • 7
  • Harald Seifert
    • 8
    • 9
  • Jean François Timsit
    • 10
    • 11
  • Jordi Vila
    • 12
  • Jean-Ralph Zahar
    • 13
  • Matteo Bassetti
    • 14
  1. 1.Unidad Clínica de Cuidados IntensivosInstituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del RocíoSevilleSpain
  2. 2.Department of Critical CareUniversity Hospital ATTIKON, Medical School, University of AthensAthensGreece
  3. 3.4th Department of Internal MedicineAthens University School of Medicine, Attikon University General HospitalAthensGreece
  4. 4.Department of Infectious DiseasesHacettepe University School of MedicineAnkaraTurkey
  5. 5.Unidad Clínicia de Enfermedades Infecciosas, Microbiología y PreventivaInstituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del RocíoSevilleSpain
  6. 6.Department of Critical Care MedicineGhent University HospitalGhentBelgium
  7. 7.2nd Infectious Disease DivisionNational Institute for Infectious Diseases ‘L. Spallanzani’RomeItaly
  8. 8.Institute for Medical Microbiology, Immunology and Hygiene, University of CologneCologneGermany
  9. 9.German Centre for Infection Research (DZIF), Partner Site Bonn-CologneBonnGermany
  10. 10.Medical and Infectious Diseases ICUBichat HospitalParisFrance
  11. 11.University Paris-Diderot - Inserm U1137 - IAMEParisFrance
  12. 12.Department of Clinical Microbiology, CDB, Hospital Clínic, School of MedicineUniversity of Barcelona, Centre for International Health Research, (CRESIB-Hospital Clínic)BarcelonaSpain
  13. 13.Unité de Prévention et de Lutte Contre les Infections NosocomialesUniversité d’Angers, Centre Hospitalo-universitaire d’AngersAngersFrance
  14. 14.Infectious Diseases ClinicSanta Maria Misericordia University HospitalUdineItaly

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