Urgent Fight against Acinetobacter baumannii in Hospitals: Strengthening Infection Control and Antibiotic Stewardship

To the Editor, Acinetobacter baumannii has emerged as a critical multidrug-resistant pathogen posing an escalating threat in the hospital settings. It has a remarkable ability to acquire and share the resistance genes even those for last resort antibiotics such as carbapenems.[1] Since we know its genetic flexibility and environmental hardiness, we should turn our attention to proactive and aggressive infection prevention efforts to stop its unrelenting spread within healthcare settings. A. baumannii thrives as a resistant pathogen due to its elaborate defence strategies. It breaks down antibiotics by producing β-lactamases of Ambler classes A, B, C, and D.[2,3] In addition to other mechanisms, it can pump out drugs from the cells and mutations can change drug targets making antibiotics ineffective. Importantly, the resistance genes are often located within mobile genetic elements that enable rapid horizontal transfer among other bacteria. This ability to acquire genes quickly, coupled with its capacity to survive on dry surfaces for long periods makes it an excellent vehicle for the spread of resistance within hospitals.[3,4] A. baumannii infections have pronounced clinical implications. Multi-drug resistant, extensively drug-resistant and pandrug-resistant strains leave very limited, treatment options for the clinicians. It also results in prolonged hospital stay, higher financial costs for families and healthcare system, and increased morbidity and mortality of patients.[5] This means that we should put more efforts on the Infection prevention and control (IPC) strategies. Hand hygiene by all healthcare personnel has proved to be the simplest way but most effective against the prevention of transmission. Equally important is cleaning and disinfection of patient rooms, shared equipment, and high-touch surfaces with hospital-grade disinfectants; that is, eliminating the persistent environmental reservoirs. Direct and indirect cross-transmission of resistant strains must also be prevented with strict contact precautions for colonized or infected patients. Active surveillance cultures can provide a pathway through which these colonized individuals can be picked up early enough and isolated so as not to allow wider dissemination.[6,7] Implementing antibiotic stewardship programs (ASPs) is really important. They help in rational use of antibiotics which is essential to limit the selective pressure that allows resistant strains to emerge. ASPs helps to preserve the efficacy of existing antibiotics and reduce emergence and spread of resistant bacterial strains. An ASP for A. baumannii should focus on carbapenem-sparing strategies, de-escalation, and infection control, supported by rapid diagnostics and local antibiograms.[7] Restricting carpabenem use in the intensive care unit has demonstrated a twofold decrease in the incidence of carbapenem-resistant A. baumannii infections.[8] Rapid diagnostic tools include molecular methods such as loop-mediated isothermal amplification, recombinase polymerase amplification, and quantitative polymerase chain reaction that can identify the bacteria within hours. Other techniques such as matrix-assisted laser desorption ionization-time of flight mass spectrometry can also provide rapid identification. Finally, although we urgently require new antibiotics and alternative treatments in the long term, we must promptly invest in research to fully understand how A. baumannii disseminates. Understanding its pathways enables us to create accurate and efficient infection control strategies. The implementation of comprehensive and coordinated multidisciplinary strategy incorporating these three pillars of the advanced diagnostics, antibiotic stewardship, and rigorous IPC practices is essential to contain the threat of this superbug. Only through this proactive and coordinated approach we can safeguard our capacity to treat future infections. Sincerely, Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.