Institutional outbreaks caused by Acinetobacter baumannii strains that have acquired
multiple mechanisms of antimicrobial drug resistance constitute a growing public-health
problem. Because of complex epidemiology, infection control of these outbreaks is
difficult to attain. Identification of potential common sources of an outbreak, through
surveillance cultures and epidemiological typing studies, can aid in the implementation
of specific control measures. Adherence to a series of infection control methods including
strict environmental cleaning, effective sterilisation of reusable medical equipment,
attention to proper hand hygiene practices, and use of contact precautions, together
with appropriate administrative guidance and support, are required for the containment
of an outbreak. Effective antibiotic treatment of A baumannii infections, such as
ventilator-associated pneumonia and bloodstream infections, is also of paramount importance.
Carbapenems have long been regarded as the agents of choice, but resistance rates
have risen substantially in some areas. Sulbactam has been successfully used in the
treatment of serious A baumannii infections; however, the activity of this agent against
carbapenem-resistant isolates is decreasing. Polymyxins show reliable antimicrobial
activity against A baumannii isolates. Available clinical reports, although consisting
of small-sized studies, support their effectiveness and mitigate previous concerns
for toxicity. Minocycline, and particularly its derivative, tigecycline, have shown
high antimicrobial activity against A baumannii, though relevant clinical evidence
is still scarce. Several issues regarding the optimum therapeutic choices for multidrug-resistant
A baumannii infections need to be clarified by future research.