One of my many pet peeves is that nobody takes ‘ordinary’ bacterial infections seriously. I originally wrote this post Jan. 8, 2006, but I was ranting about Acinetobacter since the previous August. The good news is that people other than infectious disease specialists are worrying about it. The bad news is that the Infectious Disease Society of America states that there’s no antibiotic in the pipeline to treat multidrug resistant Acinetobacter.
One of the talks I heard at the ICAAC meeting was about the emerging pathogen Acinetobacter baumannii (given by Yehuda Carmeli). Israel is having serious problems with Acinetobacter infections (both sepsis infections and pneumonia for patients on ventilators). What makes this bacterium so terrifying is that it’s multidrug resistant, and in some cases, resistant to everything we can currently throw at it. The only drug that (almost always) works is colistin which has serious side effects, and is not widely manufactured.
In Israel, the mortality rate for antibiotic resistant Acinetobacter infections is six times that of sensitive infections (mortality usually results from treatment failure due to using antibiotics that are ineffective). However, this underestimates the problem. The resistant Acinetobacter infections are additional infections. In other words, MDRA (multidrug resistant Acinetobacter) is not replacing infections caused other sensitive bacteria-these are new cases that otherwise would not have happened.
When Carmeli extrapolated to the U.S., he estimated that this would yield an additional 25,000 – 30,000 deaths per year in the U.S. To put this in perspective, AIDS killed 18,000 in the U.S. last year, influenza kills ~36,000 per year, and breast cancer kills 40,000 per year. And worrying about Acinetobacter is not needless hyperventilating. Israel is having massive problems with MDRA, as well as Saudi Arabia, Kuwait, and Mexico (in the tropics, Acinetobacter is also associated with community-acquired pneumonia). And after talking with several people who conduct antibiotic resistance surveillance at hospitals around the U.S., it’s safe to say that MDRA is emerging here too.
So what to do? First, we need to fund antibiotic resistance surveillance systems and devote resources to track Acinetobacter; these surveillance systems also have to incorporate genetic information, not just antibiotic resistance data. Second, we need to learn a lot more about this organism-we don’t even know where it lives outside of clinical settings. Third, we need rigorous infection control procedures at medical facilities similar to those adopted for controlling MRSA.
Or maybe we should just give Paris Hilton a tax cut.