INFECTIONS DUE TO ACINETOBACTER-BAUMANNII

Acinetobacter baumannii is currently recognised as being responsible of severe nosocomial infections, particularly in intensive care units. An investigation carried out in 1991 in French intensive care units showed that the principal infections are pulmonary, urinary or septicemic in the medical field, as opposed to being suppurative in the surgical field a few years ago. The major problems posed by the Acinetobacter spp at the present time are the increase in their incidence in intensive care units, their persistence and their multiresistance to the major antibiotic families, beta-lactams, aminoglycosides and quinolones. Ten clinical cases of patients presenting an infection with Acinetobacter baumannii were treated based on the results of the antibiogram, by ticarcillin associated or not with clavulanic acid; 6 patients received a preceding antibiotherapy; the infections with Acinetobacter were distributed as follow : 8 pneumonias including one with positive hemoculture and 2 bacteraemias associated with peripheral venous catheters confirmed by repeated positive hemocultures. The clinical and bacteriological evolution was favourable in 7 cases; 3 patients died of which one death was not due to nosocomial infection. In one case a strain of Acinetobacter baumannii resistant to all beta-lactams, with the exception of imipenem, was isolated under treatment. Although imipenem is often the only product which is active against this bacteria, the investigation carried out in 1991 showed that ticarcillin retained an activity against 53 % of the strains and the association with aminoglycosides (amikacin or netilmicin) is bactericidal. The associations of beta-lactams with beta-lactamase inhibitors may be an interesting alternative therapy.