Multidrug-resistant <i>Acinetobacter</i> – a challenge for public health<br><b>[Abstract in English]</b>

Abstract

AIMS: To discuss the various aspects associated with the emergence of carbapenem resistance in isolates of Acinetobacter baumannii and the spread of epidemic clones. SOURCE OF DATA: We consulted the databases SciELO, PubMed and Science Direct. We included articles published in English, primarily from 2000 to 2011. The key words were Acinetobacter, multidrug resistance, outbreaks, infection control measures, and risk factors. SUMMARY OF FINDINGS: Acinetobacter baumannii is an opportunistic pathogen involved in a wide spectrum of nosocomial infections, including bacteremia, meningitis and urinary tract infection. It is most prevalent as an agent of nosocomial pneumonia, particularly pneumonia associated with mechanical ventilation in intensive care units. Carbapenem antibiotics have been used as treatment of choice for infections caused by Acinetobacter, but currently the high rates of resistance to this class of antimicrobials have limited the therapeutic options. Resistance to carbapenem may be related to the loss of porins, to class B beta-lactamases (metallo-beta-lactamases) and more significantly, to the production class D beta-lactamases (OXA-type carbapenemases). Outbreaks associated with the production of OXA-carbapenemases have been reported in different countries since the late 1990s, and the spread of epidemic clones have been documented. CONCLUSIONS: The high number of outbreaks already reported in the literature, the ease of spread of epidemic clones and the difficulty in treating, make Acinetobacter infections a serious public health problem.