From the Guidelines
The recommended treatment for Acinetobacter mastitis is sulbactam, given its intrinsic activity against A. baumannii and the recent PK/PD study supporting its use 1.
Treatment Options
- Sulbactam is a penicillanic acid sulfone with intrinsic activity against A. baumannii, and a recent PK/PD study concluded that a 4-h infusion of 3 g of sulbactam every 8 h constitutes the best treatment option for isolates with a higher MIC of 8 mg/L 1.
- The use of sulbactam has been supported by several studies, including a randomized study that evaluated the efficacy and safety of two sulbactam regimens in patients with VAP caused by multi-drug-resistant (MDR) A. baumannii, showing similar clinical and bacteriological cure rates with both regimens and excellent tolerance 1.
- Another study compared ampicillin-sulbactam with colistin in patients with MDR A. baumannii VAP, showing comparable clinical and microbiological response, but with higher nephrotoxicity in the colistin group 1.
Alternative Treatments
- Colistin is an alternative treatment option, but its use is associated with higher nephrotoxicity and lower effectiveness compared to sulbactam 1.
- Tigecycline is another alternative, but its use is not recommended as monotherapy for the treatment of pneumonia, and its combination with other antibiotics should be considered only if the tigecycline MIC is ≤2 mg/L 1.
Supportive Care
- Supportive measures, such as frequent breast emptying through pumping or nursing, warm compresses to reduce inflammation, adequate hydration, and pain management with acetaminophen or ibuprofen, are essential for the treatment of Acinetobacter mastitis.
Duration of Treatment
- The duration of treatment for Acinetobacter mastitis generally ranges from 7-14 days, depending on the clinical response and the results of antimicrobial susceptibility testing 1.
From the FDA Drug Label
Tigecycline has been shown to be active against most of the following microorganisms, both in vitro and in clinical infections... Gram-negative bacteria ... Acinetobacter baumannii*
*There have been reports of the development of tigecycline resistance in Acinetobacter infections seen during the course of standard treatment.
The recommended treatment for Acinetobacter mastitis is not explicitly stated in the drug label. However, based on the information provided, tigecycline has been shown to be active against Acinetobacter baumannii in vitro.
- Key points:
- Tigecycline may be effective against Acinetobacter infections.
- Resistance to tigecycline has been reported in Acinetobacter infections.
- Monitoring for relapse of infection is important, especially in cases where resistance is suspected. 2
From the Research
Treatment of Acinetobacter Mastitis
The recommended treatment for Acinetobacter mastitis is based on the severity of the infection and the susceptibility of the bacteria to antibiotics.
- For mild cases, treatment with antibiotics such as ceftazidime 3 may be effective.
- For more severe cases, combination therapy with antibiotics such as ceftazidime/avibactam and colistin, tobramycin, or tigecycline may be necessary 4.
- It is essential to obtain drainage cultures to guide antibiotic therapy, as Acinetobacter baumannii can be resistant to multiple antimicrobial agents 3, 5, 6.
- Minocycline has been shown to have activity against Acinetobacter species, including MDR strains, and may be a potential treatment option 6.
Antibiotic Resistance
Acinetobacter baumannii is often multidrug-resistant, making treatment challenging.
- Carbapenems, polymyxins, and sulbactam are commonly used to treat Acinetobacter infections, but resistance to these antibiotics is increasing 5.
- The use of combination therapy and newer antibiotics such as ceftazidime/avibactam may be effective against MDR strains 4.
- It is crucial to monitor antibiotic resistance patterns and adjust treatment accordingly 5, 6.
Prevention and Management
Prevention and management of Acinetobacter mastitis involve proper lactation techniques and avoiding overstimulation of milk production.