Treatment of Acinetobacter baumannii severe infections

Detection of AdeAB, TetA, and TetB efflux pump genes in clinical isolates of tetracycline-resistant Acinetobacter baumannii from patients of Suez Canal University Hospitals

BACKGROUND

Acinetobacter baumannii is an opportunistic bacteria associated primarily with hospital-acquired infections. Its tendency to acquire or donate resistance genes to neighboring bacteria is a major concern. Tetracyclines have shown promise in treating A. baumannii infections, but tetracycline resistance is growing globally in A. baumannii isolates.

OBJECTIVES

The study aimed to study (1) the prevalence of multidrug-resistant (MDR) A. baumannii infections at Suez Canal University Hospitals, (2) the distribution of efflux pump genes AdeA &B, TetA, and TetB, and (3) the effect of efflux pump inhibitor (CCCP) on tetracycline-resistant isolates.

METHODS

Clinical samples (457) were collected (blood, urine, sputum, ETA, pus, and pleural fluid), followed by A. baumannii isolation and identification, PCR detection of efflux pump genes, and detection of tetracycline susceptibility and its MIC before and after treatment with the efflux pump inhibitor (CCCP).

RESULTS

A total of 31 A. baumannii isolates were recovered (6.78%). The highest rate of isolation was from the ICU (48.3%) from the ET aspirate samples (48.3%). The efflux system AdeA and TetB genes were distributed in 100% of isolates, whereas AdeB was found in 93.5% of isolates and the TetA gene in 87.1% of isolates. All A. baumannii isolates were MDR showing resistance to three or more classes of antibiotics. 45% of the isolates showed a 4-fold reduction of MIC and 12.9% showed a 2-fold reduction in the MIC.

CONCLUSIONS

Efflux pump is an important mechanism for tetracycline resistance among A. baumannii isolates.

Bactericidal and Synergistic Effects of Lippia origanoides Essential Oil and Its Main Constituents against Multidrug-Resistant Strains of Acinetobacter baumannii

Bacterial resistance in Acinetobacter baumannii is a significant public health challenge, as these bacteria can evade multiple antibiotics, leading to difficult-to-treat infections with high mortality rates. As part of the search for alternatives, essential oils from medicinal plants have shown promising antibacterial potential due to their diverse chemical constituents. This study evaluated the antibacterial, antibiofilm, and synergistic activities of the essential oil of Lippia origanoides (EOLo) and its main constituents against multidrug-resistant clinical isolates of A. baumannii. Additionally, the antibacterial and antibiofilm potential of a nanoemulsion containing carvacrol (NE-CAR) was assessed. EOLo was extracted through hydrodistillation, and its components were identified via gas chromatography coupled with mass spectrometry. The A. baumannii isolates (n = 9) were identified and tested for antimicrobial susceptibility using standard disk diffusion methods. Antibacterial activity was determined by broth microdilution, while antibiofilm activity was measured using colorimetric methods with crystal violet and scanning electron microscopy. Synergism tests with antibiotics (meropenem, ciprofloxacin, gentamicin, and ampicillin+sulbactam) were performed using the checkerboard method. The primary constituents of EOLo included carvacrol (48.44%), p-cymene (14.58%), and thymol (10.16%). EOLo, carvacrol, and thymol demonstrated significant antibacterial activity, with carvacrol showing the strongest effect. They were also effective in reducing biofilm formation, as was NE-CAR. The combinations with antibiotics revealed significant synergistic effects, lowering the minimum inhibitory concentration of the tested antibiotics. Therefore, this study confirms the notable antibacterial activity of the essential oil of L. origanoides and its constituents, especially carvacrol, suggesting its potential as a therapeutic alternative for A. baumannii infections.

A review of the fighting Acinetobacter baumannii on three fronts: antibiotics, phages, and nanoparticles

In the current era of antibiotic resistance, researchers are exploring alternative ways to treat bacterial infections that are resistant to multiple drugs. Acinetobacter baumannii (A. baumannii) is a bacterium that is commonly encountered in clinical settings and is known to be resistant to several drugs. Due to the increase in drug-resistant infections caused by this bacteria, there is an urgent need to investigate alternative treatment options such as phage therapy and combination therapy. Despite the success of phages in some cases, there are some limitations in their clinical application that can be overcome by combining phages with other substrates such as nanoparticles to improve their function. The integration of nanotechnology with phage therapy against A. baumannii promises to overcome antibiotic resistance. By exploiting the targeted delivery and controlled release capabilities of nanoparticles, we can enhance the therapeutic potential of phages while minimizing their limitations. Continued research in this field will undoubtedly pave the way for more effective and precise treatments against A. baumannii infections and provide hope in the fight against antibiotic-resistant bacteria.

Sub-inhibitory concentrations of colistin and imipenem impact the expression of biofilm-associated genes in Acinetobacter baumannii

Acinetobacter baumannii is an opportunistic pathogen that is responsible for nosocomial infections. Imipenem and colistin are drugs that are commonly used to treat severe infections caused by A. baumannii, such as sepsis, ventilator-associated pneumonia, and bacteremia. However, some strains of A. baumannii have become resistant to these drugs, which is a concern for public health. Biofilms produced by A. baumannii increase their resistance to antibiotics and the cells within the inner layers of biofilm are exposed to sub-inhibitory concentrations (sub-MICs) of antibiotics. There is limited information available regarding how the genes of A. baumannii are linked to biofilm formation when the bacteria are exposed to sub-MICs of imipenem and colistin. Thus, this study's objective was to explore this relationship by examining the genes involved in biofilm formation in A. baumannii when exposed to low levels of imipenem and colistin. The study found that exposing an isolate of A. baumannii to low levels of these drugs caused changes in their drug susceptibility pattern. The relative gene expression profiles of the biofilm-associated genes exhibited a change in their expression profile during short-term and long-term exposure. This study highlights the potential consequences of overuse and misuse of antibiotics, which can help bacteria become resistant to these drugs.