NECESSITY OF COMBINATION THERAPY WITH COLISTIN ANDTIGECYCLINE FOR ACINETOBACTER BAUMANNII INFECTIONS

摘要

Acinetobacter baumannii is amongst the leading cause of mortality in intensive care units (ICU) settings. 1,2 This bacteria belongs to agroup of gram negative rods and can cause life threatening nosocomial pneumonia, urinary tract infection (UTI), meningitis and severewound infections. 3 The emerging carbapenam resistant trend of this bug and hence management options for Acinetobacterbaumannii (MDR- AB) strains is a challenging task for the health care providers globally. Besides that the organism's ability towithstand environmental changes and prolonged survival adds up for its endemic nature. 2,3A. baumannii colonizes the superficial skin surfaces without producing any infection. But in immunosuppressed patients especiallythe ones having open wounds, or tracheostomy, this organism becomes an opportunistic one and leads to severe life threateninginfection. The important risk factors for acquiring this infections includes mechanical ventilation, major surgeries, central venous,dialysis or urinary catheter, indwelling vascular devices and the overuse of broad-spectrum antibiotics. The infection can spread fromperson-to-person contact, reuse of contaminated equipment like breathing tubes, catheters, laryngoscopes etc etc. Strict infectioncontrol protocols needs to be followed for the prevention of spreading this infection. 4Karabay et al conducted a study in Turkery, and disclosed that the estimated mortality rates of nosocomial infections with A.baumanniiis 77%.5 A published report for the year 2000, had shown that in USA and Taiwan, the specific nosocomial infection ranked on the fifthnumber.6 However two researches from Turkey disclosed that it is amongst the leading cause of gram negative nosocomial meningitis.The resistant pattern emergence and difficulty in successful management can be the added factors for high mortality rate in hospitals.The factors responsible for the resistant nature include the degrading beta lactam enzymes, alteration in penicillin binding proteins,and the changes in outer membrane proteins.