**6. Treatment, prevention and control**

Treatment of Acinetobacter infections should be individualized according to results of susceptibility testings. For effective treatment of Acinetobacter infections the combination therapy is usually required. Infections caused by antibiotic-susceptible Acinetobacter isolates have usually been treated with broad-spectrum cephalosporins, combinations of β-lactam:βlactamase inhibitor or carbapenems, used alone or in combination with an aminoglycoside (Evans et al., 2012). The duration of treatment is similar to that for infections caused by other gram-negative bacilli.

Antibiotic choices may be limited in cases of infections caused by multidrug-resistant isolates. The emergence of multidrug-resistant Acinetobacter strains has brought the old antibiotic polymyxins back into clinical use. These antibiotics disrupt bacterial cytoplasmic membranes, causing leakage of cytoplasmic contents. Clinicians stoped using this antibiotic in 1970s due to several side effects in kidneys and neurons.

Another treatment option remain tigecycline, a new glycylcycline antibiotic. However, development of resistance to these last option antibiotics has been reported recently (Gimar‐ ellou & Poulakou, 2012).

Prevention and control of infections caused by Acinetobacter requires a coordinated effort involving all stakeholders including healthcare facilities and providers, public health, and industry (Siegel et al., 2007). CDC and APIC has recommend the cornerstones for prevention and control of multidrug resistant organisms, including Acinetobacter infections (CDC,2012; APIC,2010). Key measures to control spread of multi-drug resistant organisms are:


common environmental samples include swabs on surfaces of machines, wash-hand basins,

Microbiologic cultures can be processed by standard methods on routine media. For routine clinical and laboratory investigations, traditional culture media are used: agar, brain heart infusion agar, tryptic soy agar, Eosin-methylene blue, MacConkey agar, Violet red bile agar, Luria Bertani agar and Holton medium. For environmental screening the most commonly used media are broth media such as MacConkey's broth, trypton soy, Brain Heart Infusion and Luria broth. Antimicrobial susceptibility can be determined by various means, with the agar-dilution

Biochemical typing methods include the use of colorimetric based GN card ID 32 GN, API

For detection of Acinetobacter strains a new molecular identification and typing methods have beendeveloped,leadingtosuccessfulidentificationandoutbreakmanagement(Eckeretal.,2006). The most important of them are : polymerase chain reaction (PCR), PFGE, RAPD-PCR DNA fingerprinting, fluorescent in situ hybridization (FISH), 16S rRNA gene restriction analysis (ARDRA) (amplified rDNA restriction analysis) and 16S rRNA gene PCR-DGGE (Denaturing GradientGelElectrophoresis)fingerprinting(Versalovicetal.,2011).Arecentdiagnosticmethod which was reported to have high specificity and can discriminate between Acinetobacter species is the microsphere-based array technique that combines an allele specific primer extension assay and microsphere hybridization. The use of DNA-DNA hybridization and sequence analysis is considered the gold standard, but the method is time consuming and impractical in most clinical

Other methods that have been introduced in the epidemiological investigation of outbreaks caused by Acinetobacter spp. include biotyping, phage typing, cell envelope protein typing, plasmid typing, ribotyping, restriction fragment length polymorphisms and arbitrarily primed

Treatment of Acinetobacter infections should be individualized according to results of susceptibility testings. For effective treatment of Acinetobacter infections the combination therapy is usually required. Infections caused by antibiotic-susceptible Acinetobacter isolates have usually been treated with broad-spectrum cephalosporins, combinations of β-lactam:βlactamase inhibitor or carbapenems, used alone or in combination with an aminoglycoside (Evans et al., 2012). The duration of treatment is similar to that for infections caused by other

Antibiotic choices may be limited in cases of infections caused by multidrug-resistant isolates. The emergence of multidrug-resistant Acinetobacter strains has brought the old antibiotic polymyxins back into clinical use. These antibiotics disrupt bacterial cytoplasmic membranes, causing leakage of cytoplasmic contents. Clinicians stoped using this antibiotic in 1970s due

floors, tables, UV lamps, etc.

88 Infection Control

laboratories.

PCR (AP-PCR).

gram-negative bacilli.

method being the gold-standard (CLSI, 2011).

20NE, RapID NF Plus and Vitek 2 systems.

**6. Treatment, prevention and control**

to several side effects in kidneys and neurons.


Infection control measures should start with strict isolation and cohorting of infected or colon‐ ized patients accompanied by administrative measures, education, prudent antimicrobial use, surveillance, standard precautions to prevent transmission and environmental measures.

Control of hospital outbreaks caused by Acinetobacter species is an important challenge for all health care settings. If a source and/or reservoir are identified, than the outbreak is successfully controlled by the eradication of that source/reservoir. In other circumstances, various measures may be used, including unit closure, cohorting of patients and staff, strict hand hygiene, contact or strict isolation, environmental disinfection and discharge of colonized patients.

A review of 51 hospital outbreaks showed that 25 had a common source: 13 outbreaks with predominantly respiratory tract infections and 12 with predominantly bloodstream or other infections were controlled by removal or disinfection and sterilization of contaminated ventilator (or related) equipment or contaminated moist fomites (Villegas & Hartstein, 2003).

When neither common sources nor environmental reservoirs are identified, control has depended on active surveillance and contact isolation for colonized and infected patients, improvements in the hand hygiene of health care workers and aseptic care of vascular catheters and endotracheal tubes.
