INFECTIONS DUE TO ACINETOBACTER-BAUMANNII

Acinetobacter baumannii is currently recognised as being responsible o f severe nosocomial infections, particularly in intensive care units. An investigation carried out in 1991 in French intensive care units sh owed that the principal infections are pulmonary, urinary or septicemi c in the medical field, as opposed to being suppurative in the surgica l field a few years ago. The major problems posed by the Acinetobacter spp at the present time are the increase in their incidence in intens ive care units, their persistence and their multiresistance to the maj or antibiotic families, beta-lactams, aminoglycosides and quinolones. Ten clinical cases of patients presenting an infection with Acinetobac ter baumannii were treated based on the results of the antibiogram, by ticarcillin associated or not with clavulanic acid; 6 patients receiv ed a preceding antibiotherapy; the infections with Acinetobacter were distributed as follow : 8 pneumonias including one with positive hemoc ulture and 2 bacteraemias associated with peripheral venous catheters confirmed by repeated positive hemocultures. The clinical and bacterio logical 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 excep tion of imipenem, was isolated under treatment. Although imipenem is o ften the only product which is active against this bacteria, the inves tigation carried out in 1991 showed that ticarcillin retained an activ ity against 53 % of the strains and the association with aminoglycosid es (amikacin or netilmicin) is bactericidal. The associations of beta- lactams with beta-lactamase inhibitors may be an interesting alternati ve therapy.