What is the treatment for Acinetobacter lwoffii infections?

Treatment of Acinetobacter lwoffii Infections

For Acinetobacter lwoffii infections, imipenem is the most effective first-line treatment, with a 57% sensitivity rate reported in clinical studies. 1

Antimicrobial Options for A. lwoffii

A. lwoffii is an opportunistic pathogen that can cause various infections including bacteremia, pneumonia, meningitis, urinary tract infections, and wound infections. Treatment options include:

First-line options:

• Carbapenems: Imipenem shows the highest sensitivity (57%) 1
  • FDA-approved for treating Acinetobacter species infections in multiple body sites including lower respiratory tract, skin/soft tissue, and bacteremia 2

Alternative options (based on susceptibility):

• Cotrimoxazole (32% sensitivity) 1
• Fluoroquinolones like ciprofloxacin (21% sensitivity) 1
• Amoxicillin-clavulanic acid (7% sensitivity) 1
• Cefuroxime (3.5% sensitivity) 1

Treatment Algorithm

1. Assess infection severity:

   • For severe infections (sepsis/septic shock):
     • Start with imipenem if in an endemic setting or previously colonized patient 3
     • Consider combination therapy for severe infections with poor response to monotherapy

2. For confirmed A. lwoffii infection:

   • Obtain susceptibility testing immediately
   • Use imipenem as empiric therapy while awaiting results
   • Adjust based on susceptibility results

3. Duration of therapy:

   • For severe infections (bacteremia, pneumonia): maintain antimicrobial therapy for 2 weeks 3
   • For less severe infections: shorter duration may be acceptable 3

Special Considerations

For respiratory infections:

• Consider nebulized antibiotics (aminoglycosides or colistin) as adjunctive therapy for pulmonary infections not responding to systemic therapy 3

For multidrug-resistant strains:

• Consider combination therapy with sulbactam or a polymyxin plus a second agent (tigecycline, rifampicin, or fosfomycin) for clinical failures 3

Clinical Pearls and Pitfalls

• Pitfall: A. lwoffii is increasingly showing multidrug resistance, particularly in neonatal ICU settings 1
• Pitfall: Delayed appropriate therapy can lead to increased mortality in Acinetobacter infections 4
• Pearl: Knowledge of local susceptibility patterns is crucial for guiding empiric therapy 4
• Pearl: A. lwoffii can cause community-acquired infections, including gastroenteritis with bacteremia 5

High-Risk Populations

• Immunocompromised patients 6
• Premature and very low birth weight neonates 1
• ICU patients, especially those on mechanical ventilation 3

Regular monitoring of organ function (renal, hepatic, hematopoietic) is advisable during prolonged therapy with carbapenems 2.