Emergence of Extensively drug-resistant Acinetobacter spp in a tertiary care centre of Hyderabad, Telangana state

Acinetobacter spp., a gram negative coccobacillus, were considered to be opportunistic pathogen till their role in hospital acquired infections was described. It has been declared as one of the ESKAPE pathogens which effectively escapes the effects of antimicrobial drugs due to several resistance mechanisms. Of utmost concern is the emerging drug resistance to Carbapenems.

The clinical specimens received were processed according to standard microbiology procedures and the organism was identified as Acinetobacter spp. Antimicrobial susceptibility testing was performed and the organisms were classified as Multidrug resistant (MDR), Extremely drug resistant (XDR) and Pan drug resistant (PDR).

Acinetobacter spp were isolated predominantly in endotracheal aspirates (58.1%), suction tip (21.2%) and tracheal tip cultures (4.96%). There was decreased antimicrobial susceptibility to aminoglycosides, β lactam and β lactam inhibitor combination, fluoroquinolones and carbapenems. Out of 143 isolates, MDR were 131 (91.6%) and XDR were 126 (88.1%). However no isolate was PDR. Majority of MDR and XDR strains were isolated from respiratory intensive care unit (RICU) (65.7% and 63.6% respectively).

Rise in carbapenem resistance in Acinetobacter spp. is quite alarming, as it leads to unchecked use of colistin, a last resort antibiotic. To avoid antimicrobial resistance, antibiotics should be used cautiously and empirical therapy should be formulated based on local antimicrobial sensitivity pattern. Antibiotic de-escalation therapy should be practiced based on the culture and sensitivity report. As it is a nosocomial pathogen, the health care workers have to be trained properly in infection control practices to prevent the transmission of this notorious pathogen.