title: Nosocomial Infections Caused by Acinetobacter baumannii: Are We Losing the Battle?
abstract: BACKGROUND
  The incidence of nosocomial infections caused by multi-drug- and extended-drug resistant strains of Acinetobacter is constantly increasing all over the world, with a high mortality rate. We analyzed the in-hospital data on the sensitivity of Acinetobacter baumannii isolates and correlated them with antibiotic treatment and clinical outcomes of nosocomial infections over a 17-mo period.
  
  
  METHODS
  Retrospective analysis was performed at the Clinical Center "Bezanijska kosa," Belgrade, Serbia. Microbiologic data (number and sensitivity of A. baumannii isolates) and clinical data (medical records of 41 randomly selected patients who developed nosocomial infection caused by A. baumannii) were matched.
  
  
  RESULTS
  Acinetobacter baumannii, detected in 279 isolates and obtained from 19 patients (12% of all samples), was resistant to almost all antibiotics tested, including carbapenems, with the exception of colistin and tigecycline. It was obtained most often from the respiratory tract samples. Empiric treatment of the nosocomial infections (pneumonia in 75% of cases) involved cephalosporins, metronidazole, and carbapenems (80%, 66%, and 61% of patients, respectively), whereas tigecyclin and colistin were used primarily in targeted therapy (20% and 12% of patients, respectively). The mortality rate of patients treated empirically was significantly higher (p < 0.01), reaching 100% in the elderly.
  
  
  CONCLUSIONS
  Nosocomial A. baumannii infections represent a significant clinical problem because of their high incidence, lack of susceptibility to the most commonly used antibiotics, and the often inappropriate treatment, which favors the development of multi-drug-resistant strains.
authors.affiliation: 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia .
authors.forename: Dragana
authors.initials: D
authors.lastname: Protic
authors.affiliation: 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia .
authors.forename: Aleksa
authors.initials: A
authors.lastname: Pejovic
authors.affiliation: 2 Medical Center "Bezanijska kosa ," Belgrade, Serbia .
authors.forename: Dragana
authors.initials: D
authors.lastname: Andjelkovic
authors.affiliation: 3 High Medical School "Milutin Milanković ," Belgrade, Serbia .
authors.forename: Nina
authors.initials: N
authors.lastname: Djukanovic
authors.affiliation: 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia .
authors.forename: Dragana
authors.initials: D
authors.lastname: Savic
authors.affiliation: 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia .
authors.forename: Pavle
authors.initials: P
authors.lastname: Piperac
authors.affiliation: 2 Medical Center "Bezanijska kosa ," Belgrade, Serbia .|4 Institute of Epidemiology , Faculty of Medicine, University of Belgrade, Belgrade, Serbia .
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Markovic Denic
authors.affiliation: 2 Medical Center "Bezanijska kosa ," Belgrade, Serbia .|5 Faculty of Medicine, University of Belgrade , Belgrade, Serbia .
authors.forename: Marija
authors.initials: M
authors.lastname: Zdravkovic
authors.affiliation: 1 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade , Belgrade, Serbia .|2 Medical Center "Bezanijska kosa ," Belgrade, Serbia .
authors.forename: Zoran
authors.initials: Z
authors.lastname: Todorovic
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents