title: Task force on management and prevention of Acinetobacter baumannii infections in the ICU.
abstract: BACKGROUND
  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.
authors.affiliation: Unidad Clínica de Cuidados Intensivos, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Seville, Spain. jgarnachom@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.affiliation: Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: 4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.
authors.forename: Garyphallia
authors.initials: G
authors.lastname: Poulakou
authors.affiliation: Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Akova
authors.affiliation: Unidad Clínicia de Enfermedades Infecciosas, Microbiología y Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Seville, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.affiliation: Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: De Waele
authors.affiliation: 2nd Infectious Disease Division, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.|German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Seifert
authors.affiliation: Medical and Infectious Diseases ICU, Bichat Hospital, 75018, Paris, France.|University Paris-Diderot - Inserm U1137 - IAME, 75018, Paris, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: Department of Clinical Microbiology, CDB, Hospital Clínic, School of Medicine, University of Barcelona, Centre for International Health Research, (CRESIB-Hospital Clínic), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: Unité de Prévention et de Lutte Contre les Infections Nosocomiales, Université d'Angers, Centre Hospitalo-universitaire d'Angers, Angers, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000517:prevention & control*; D040981:Acinetobacter baumannii; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000517:prevention & control*; D003663:Decision Trees; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acinetobacter baumannii; Colistin; Epidemiology; Prevention; Treatment