, Volume 74, Issue 12, pp 1315–1333 | Cite as

Treatment Options for Carbapenem-Resistant and Extensively Drug-Resistant Acinetobacter baumannii Infections

  • J. Alexander Viehman
  • M. Hong Nguyen
  • Yohei DoiEmail author
Therapy in Practice


Acinetobacter baumannii is a leading cause of healthcare-associated infections worldwide. Because of various intrinsic and acquired mechanisms of resistance, most β-lactam agents are not effective against many strains, and carbapenems have played an important role in therapy. Recent trends show many infections are caused by carbapenem-resistant or even extensively drug-resistant (XDR) strains, for which effective therapy is not well established. Evidence to date suggests that colistin constitutes the backbone of therapy, but the unique pharmacokinetic properties of colistin have led many to suggest the use of combination antimicrobial therapy. However, the combination of agents and dosing regimens that delivers the best clinical efficacy while minimizing toxicity is yet to be defined. Carbapenems, sulbactam, rifampin and tigecycline have been the most studied in the context of combination therapy. Most data regarding therapy for invasive, resistant A. baumannii infections come from uncontrolled case series and retrospective analyses, though some clinical trials have been completed and others are underway. Early institution of appropriate antimicrobial therapy is shown to consistently improve survival of patients with carbapenem-resistant and XDR A. baumannii infection, but the choice of empiric therapy in these infections remains an open question. This review summarizes the most current knowledge regarding the epidemiology, mechanisms of resistance, and treatment considerations of carbapenem-resistant and XDR A. baumannii.


Minocycline Colistin Bloodstream Infection Polymyxin Tigecycline 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported in part by a research grant from the National Institutes of Health to Y.D. (R01AI104895). Y.D. has received a research grant from Merck and has served on an advisory board for Shionogi. J.A.V. has no potential conflicts of interest. M.H.N. has no potential conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • J. Alexander Viehman
    • 4
  • M. Hong Nguyen
    • 2
    • 3
    • 5
  • Yohei Doi
    • 1
    • 2
    Email author
  1. 1.Division of Infectious Diseases, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Antibiotic Management ProgramUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.XDR Pathogen LaboratoryUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Division of Infectious Diseases, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  5. 5.Division of Infectious Diseases, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

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