This protocol addresses the management of ventilator-associated pneumonia (VAP) when the causative pathogen is identified as an Acinetobacter species. Antibiotic selection is contingent on the susceptibility profile of the isolated organism.

Clinical scenario

VAP in which microbiological workup identifies an Acinetobacter species as the causative agent. The range of available antibiotic options — and therefore the treatment approach — depends on in vitro susceptibility results, making culture and susceptibility testing central to management decisions in this setting.

Treatment approach (partial)

Antibiotic therapy is guided by isolate susceptibility. When susceptibility results permit, a preferred class of agents is recommended; when the isolate is susceptible only to a narrow group of last-resort agents, a distinct intravenous regimen — potentially combined with an additional inhaled component — applies. Certain specific agents are recommended against in this setting regardless of susceptibility. The complete regimen, agent selection, and course duration are specified in the full protocol.

References

DOI: 10.1093/cid/ciw353

In patients with HAP/VAP caused by Acinetobacter species, we suggest treatment with either a carbapenem or ampicillin/sulbactam if the isolate is susceptible to these agents (weak recommendation, low-quality evidence).
In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin B) (strong recommendation, low-quality evidence), and we suggest adjunctive inhaled colistin (weak recommendation, low-quality evidence).
In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin (weak recommendation, moderate-quality evidence).
In patients with HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline (strong recommendation, low-quality evidence).

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Treatment of Ventilator-Associated Pneumonia Caused by Acinetobacter Species

References