title: Anticipating the Unpredictable: A Review of Antimicrobial Stewardship and Acinetobacter Infections.
abstract: Acinetobacter remains one of the most challenging pathogens in the field of infectious diseases owing primarily to the uniqueness and multiplicity of its resistance mechanisms. This resistance often leads to devastatingly long delays in time to appropriate therapy and increased mortality for patients afflicted with Acinetobacter infections. Selecting appropriate empiric and definitive antibacterial therapy for Acinetobacter is further complicated by the lack of reliability in commercial antimicrobial susceptibility testing devices and limited breakpoint interpretations for available agents. Existing treatment options for infections due to Acinetobacter are limited by a lack of robust efficacy and safety data along with concerns regarding appropriate dosing, pharmacokinetic/pharmacodynamic targets, and toxicity. Antimicrobial stewardship programs are essential to combat this unpredictable pathogen through use of infection prevention, rapid diagnostics, antibiogram-optimized treatment regimens, and avoidance of overuse of antimicrobials. The drug development pipeline includes several agents with encouraging in vitro activity against Acinetobacter, but their place in therapy and contribution to the armamentarium against this pathogen remain to be defined. The objective of this review is to highlight the unique challenge of treating infections due to Acinetobacter and summarize recent literature regarding optimal antimicrobial treatment for this pathogen. The drug development pipeline is also explored for future potentially effective treatment options.
authors.affiliation: College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA. wenzler@uic.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Wenzler
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goff
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA.
authors.forename: Romney
authors.initials: R
authors.lastname: Humphries
authors.affiliation: Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.|R M Alden Research Laboratory, Santa Monica, CA, USA.
authors.forename: Ellie J C
authors.initials: EJC
authors.lastname: Goldstein
keywords: Acinetobacter; Antimicrobial stewardship; Combination therapy; Outcomes; Pipeline; Resistance; Susceptibility; Synergy; Treatment