Acinetobacter baumannii Infections and Treatment
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Questions and Answers

What is the primary concern regarding antibiotic therapy for Acinetobacter baumannii infections?

  • The ineffectiveness of Polymyxins against CRAB
  • The uncertainty over whether an isolated organism is colonizing or pathogenic (correct)
  • The high cost of antibiotic therapy for CRAB infections
  • The lack of globally recognized antibiotic treatment strategy

    • What is the effect of Colistin-based combinations on hospitalization-related mortality?

  • 20% reduction in hospitalization-related mortality (correct)
  • 20% increase in hospitalization-related mortality
  • No significant effect on hospitalization-related mortality
  • 24% reduction in hospitalization-related mortality

    • What is the limitation of most studies on the effectiveness of antibiotics against CRAB infections?

  • Unadjusted conclusions (correct)
  • Lack of control groups
  • Inadequate follow-up
  • Small sample size

    • Why are combinations of antibiotics preferred over Colistin monotherapy for CRAB infections?

    <p>Colistin monotherapy is inadequate</p> Signup and view all the answers

    What is the current status of finding the most effective treatment for severe CRAB infections?

    <p>The most effective treatment is unknown despite its importance</p> Signup and view all the answers

    What is a limitation of commercially available medicines like Polymyxins?

    <p>They lack consistent In-Vivo CRAB effect</p> Signup and view all the answers

    What is the approximate range of the crude mortality rate of Acinetobacter.baumannii in ventilator-associated pneumonia, meningitis, and bacteremia?

    <p>25 to 70%</p> Signup and view all the answers

    What type of antibiotic resistance is Acinetobacter.baumannii resistant to, leading to a significant medical problem?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of combination treatment in treating Acinetobacter.baumannii infections?

    <p>To promote antibiotic synergy</p> Signup and view all the answers

    What is the current limitation of using Tigecycline in bloodstream infections?

    <p>Low plasma levels</p> Signup and view all the answers

    What is the recommended treatment approach for critically ill or high-risk CRAB patients?

    <p>Combination therapy with Meropenem, Polymyxin B, and Ampicillin/Sulbactam</p> Signup and view all the answers

    Which antibiotic has been linked to resistance development, leading to a recommendation for individualized doses and non-Carbapenem therapies?

    <p>Carbapenem</p> Signup and view all the answers

    What is the potential benefit of using dual β-Lactam antibiotics, such as Cefiderocol and Meropenem, in treating CRAB?

    <p>Synergistic benefits</p> Signup and view all the answers

    Which FDA-approved antibiotic is used for treating severe intraabdominal infections (IAIs) with lower MICs against CRAB than Tigecycline?

    <p>Eravacycline</p> Signup and view all the answers

    What is the target of Eravacycline in treating CRAB infections?

    <p>OXA Carbapenemases Class D β-Lactamases enzymes</p> Signup and view all the answers

    What is the current limitation of using Eravacycline in treating CRAB infections, based on in-vivo investigations?

    <p>It is less effective against CRAB than other anti-CRAB Tetracycline derivatives</p> Signup and view all the answers

    In CRAB infection management, what is a crucial factor in reducing mortality?

    <p>Eradication of eradicable foci</p> Signup and view all the answers

    What is the optimal MIC value for Colistin to ensure effective treatment of CRAB infection?

    <p>Less than or equal to 2 µg/ml</p> Signup and view all the answers

    What is the effect of using two or more In-Vitro active medications against CRAB?

    <p>Reduced mortality compared to single In-Vitro active drug</p> Signup and view all the answers

    What is the primary reason for the reduced chances of approval for CRAB infections?

    <p>Lack of data from a small, uncontrolled group of patients</p> Signup and view all the answers

    What is a key factor influencing severe CRAB infections, including septic shock?

    <p>Ineradicable or not-eradicated foci</p> Signup and view all the answers

    What is a proposed treatment regimen for severe CRAB infections?

    <p>High-dose Extended Infusion Sulbactam/Polymyxins-based regimens with High-dose Tigecycline</p> Signup and view all the answers

    Which of the following enzymes is often associated with CRAB isolates?

    <p>Carbapenemases Class C and D β-Lactamases</p> Signup and view all the answers

    Why do CRAB isolates against Polymyxins have little impact on mortality?

    <p>Because Colistin MIC doesn't exceed 2 µg/ml</p> Signup and view all the answers

    What is the primary mechanism of Carbapenem resistance in A. baumannii isolates?

    <p>Horizontal gene transfer of Carbapenemases from Ambler Classes D or B</p> Signup and view all the answers

    What is the role of ISAba1 in Carbapenem resistance?

    <p>It is a upstream element that may contribute to Carbapenem resistance</p> Signup and view all the answers

    What is the significance of the oxaAb gene in A. baumannii?

    <p>It is a marker for speciation</p> Signup and view all the answers

    What is the most common clone involved in CRAB outbreaks?

    <p>Global Clone 2</p> Signup and view all the answers

    How does CRAB spread?

    <p>Through direct and indirect contact with infected individuals and contaminated surfaces and equipment</p> Signup and view all the answers

    What is the significance of the oxa23 gene in CRAB isolates?

    <p>It is a Carbapenemase gene</p> Signup and view all the answers

    What is the consequence of the global spread of CRAB?

    <p>Increased economic and clinical issues</p> Signup and view all the answers

    What is the significance of the number of studies reporting CRAB?

    <p>It indicates a widespread dispersion of CRAB</p> Signup and view all the answers

    What is the origin of the baumannii strain in Scotland in 1985?

    <p>It originated on the chromosome of Acinetobacter radioresistens</p> Signup and view all the answers

    What is the current global rate of Carbapenem resistance?

    <p>Around 90%</p> Signup and view all the answers

    What is the incidence rate of Carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia in critical care units?

    <p>6.3 incidents per 10,000 patient-days</p> Signup and view all the answers

    What is the definition of CRAB?

    <p>A.baumannii resistance to Imipenem/Cilastatin and Meropenem</p> Signup and view all the answers

    What is the result of the multivariate analysis in identifying independent risk factors for mortality?

    <p>Ineradicable or non-eradicated focus, septic shock, and inadequate antimicrobial therapy</p> Signup and view all the answers

    What is the purpose of identifying risk factors for mortality in severe CRAB infections?

    <p>To improve clinical outcomes</p> Signup and view all the answers

    What is the definition of appropriate antimicrobial therapy?

    <p>Administration of at least one agent with In-Vitro activity against the causative organism</p> Signup and view all the answers

    What is the category of anti-CRAB therapies that includes standard-dose or high-dose Ampicillin/Sulbactam?

    <p>High/high-dose Ampicillin/Sulbactam</p> Signup and view all the answers

    What is the result of the Cox proportional hazards regression analysis?

    <p>Ineradicable or non-eradicated focus, septic shock, and inadequate antimicrobial therapy are separate risk factors for death</p> Signup and view all the answers

    What is the common characteristic of patients who are at risk of CRAB infection?

    <p>All of the above</p> Signup and view all the answers

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