Publicação
Infecção por Acinetobacter baumannii : da patogénese à expressão epidemiológica, particularidades clínicas e desafios terapêuticos
| Resumo: | Acinetobacter baumannii is a versatile and complex microorganism which has been calling attention as a nosocomial pneumonia agent, namely in ventilator associated pneumonia. Part of its pathogeny is due to the fact it is so adaptable to hospital environment and so hard to eliminate, that it starts outbreaks which require units to close in order to be made sterile again. Recent studies indicate alcoholic disinfection as a probable source of nutrients and as trigger for resistance genes expression. Remarkable as well is its resistance to dehydration which enables it to persist on plastic and glass for long periods of time and increases the difficulty in finding and eliminating the source of hospital outbreaks. Intrinsically, A. baumannii is resistant to a large part of the antibiotics commonly used for hospital infection control. However it is also able to acquire exogenous genetic material, expressing resistances borrowed from other nosocomial bacteria such as Staphilococcus e Enterobacteriaceae, increasing the demands for an appropriate therapy. For its clinical impact, mainly related to its attraction for very vulnerable patients, but also given the hospital measures it requires , the infections has to be controlled as soon as possible in order to prevent its dissemination and the rise of an outbreak, which might have disastrous consequences. In addition to hospital infection, A.baumannii has been associated with a great number of infections in soldiers from Iraq and Afghanistan. It has also been identified as a community pneumonia agent in vulnerable individuals, which might be especially worrying given its common association with bacteremia. The difficulty in finding an antibiotic to which A. baumannii is not resistant has been one of the obstacles in antibiotic therapy. Colistin is, nowadays, the main option, in those cases, ever more frequent, in which there is carbapenem resistance. The nephrotoxicity associated with colistin makes it quite dangerous for the patient, so it efforts are still being made to find better alternatives to decrease toxicity, such as synergic therapy that allows the use of diminishing doses. It is the aim of this paper to observe the ways in which this organism has evolve in its resistance profile and what the best therapies for this infection may be. |
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| Autores principais: | Stilwell, Maria do Rosário Gonçalves Francis Pinto |
| Assunto: | Acinetobacter baumannii Infecção nosocomial Multirresistência Colistina |
| Ano: | 2015 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso restrito |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | português |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Acinetobacter baumannii is a versatile and complex microorganism which has been calling attention as a nosocomial pneumonia agent, namely in ventilator associated pneumonia. Part of its pathogeny is due to the fact it is so adaptable to hospital environment and so hard to eliminate, that it starts outbreaks which require units to close in order to be made sterile again. Recent studies indicate alcoholic disinfection as a probable source of nutrients and as trigger for resistance genes expression. Remarkable as well is its resistance to dehydration which enables it to persist on plastic and glass for long periods of time and increases the difficulty in finding and eliminating the source of hospital outbreaks. Intrinsically, A. baumannii is resistant to a large part of the antibiotics commonly used for hospital infection control. However it is also able to acquire exogenous genetic material, expressing resistances borrowed from other nosocomial bacteria such as Staphilococcus e Enterobacteriaceae, increasing the demands for an appropriate therapy. For its clinical impact, mainly related to its attraction for very vulnerable patients, but also given the hospital measures it requires , the infections has to be controlled as soon as possible in order to prevent its dissemination and the rise of an outbreak, which might have disastrous consequences. In addition to hospital infection, A.baumannii has been associated with a great number of infections in soldiers from Iraq and Afghanistan. It has also been identified as a community pneumonia agent in vulnerable individuals, which might be especially worrying given its common association with bacteremia. The difficulty in finding an antibiotic to which A. baumannii is not resistant has been one of the obstacles in antibiotic therapy. Colistin is, nowadays, the main option, in those cases, ever more frequent, in which there is carbapenem resistance. The nephrotoxicity associated with colistin makes it quite dangerous for the patient, so it efforts are still being made to find better alternatives to decrease toxicity, such as synergic therapy that allows the use of diminishing doses. It is the aim of this paper to observe the ways in which this organism has evolve in its resistance profile and what the best therapies for this infection may be. |
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