Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections
First-Line Therapy
- The Infectious Diseases Society recommends colistin-based combination therapy as the primary treatment approach for Carbapenem-Resistant Acinetobacter baumannii (CRAB) infections, with colistin with or without carbapenems, plus adjunctive inhaled colistin therapy (Weak recommendation, low quality of evidence) 1
- Colistin-carbapenem based combination therapy is recommended for CRAB infections (Weak recommendation, low quality of evidence) 1
Alternative Options
- Tigecycline-based combination therapy is considered an alternative option, except as monotherapy for pneumonia, and consideration of MIC values is recommended before initiating tigecycline (better outcomes when MIC ≤2 mg/L) 2
- Both tigecycline-based and polymyxin-based combination therapies are considered equally preferable, with the choice depending on patient condition 2
Special Considerations
- Polymyxins should be used cautiously in patients with renal insufficiency 2
- Tigecycline should be used cautiously in patients with liver insufficiency 2
Treatment of CRE Infections
- Ceftazidime-avibactam 2.5g IV q8h is recommended for CRE bloodstream infections (Weak recommendation, low quality evidence) 1
- Ceftazidime-avibactam 2.5g IV q8h is recommended for complicated urinary tract infections caused by CRE (Weak recommendation, very low quality evidence) 1
- Ceftazidime-avibactam 2.5g IV q8h is recommended for complicated intra-abdominal infections caused by CRE when combined with metronidazole (Weak recommendation, very low quality evidence) 1
Combination Therapy
- Combination therapy is generally preferred over monotherapy for CRAB infections to reduce the risk of treatment failure and emergence of resistance 1, 2
- Ceftazidime-avibactam combined with aztreonam shows synergy and is associated with lower mortality rates for CRE with metallo-β-lactamases 2, 3