Acinetobacter baumannii Antibiotic Resistance Mechanisms

Abstract

Acinetobacter baumannii is a Gram-negative ESKAPE microorganism that poses a threat to public health by causing severe and invasive (mostly nosocomial) infections linked with high mortality rates. During the last years, this pathogen displayed multidrug resistance (MDR), mainly due to extensive antibiotic abuse and poor stewardship. MDR isolates are associated with medical history of long hospitalization stays, presence of catheters, and mechanical ventilation, while immunocompromised and severely ill hosts predispose to invasive infections. Next-generation sequencing techniques have revolutionized diagnosis of severe A. baumannii infections, contributing to timely diagnosis and personalized therapeutic regimens according to the identification of the respective resistance genes. The aim of this review is to describe in detail all current knowledge on the genetic background of A. baumannii resistance mechanisms in humans as regards beta-lactams (penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors), aminoglycosides, tetracyclines, fluoroquinolones, macrolides, lincosamides, streptogramin antibiotics, polymyxins, and others (amphenicols, oxazolidinones, rifamycins, fosfomycin, diaminopyrimidines, sulfonamides, glycopeptide, and lipopeptide antibiotics). Mechanisms of antimicrobial resistance refer mainly to regulation of antibiotic transportation through bacterial membranes, alteration of the antibiotic target site, and enzymatic modifications resulting in antibiotic neutralization. Virulence factors that may affect antibiotic susceptibility profiles and confer drug resistance are also being discussed. Reports from cases of A. baumannii coinfection with SARS-CoV-2 during the COVID-19 pandemic in terms of resistance profiles and MDR genes have been investigated.

Keywords: Acinetobacter baumannii; CRAB; antibiotic; antimicrobial; extensive drug resistant; multidrug resistant; next-generation sequencing; pandrug resistant; resistance.

Figure 1

Mechanisms of antibiotic resistance in A. baumannii. Antibiotic resistance can be conferred through three main mechanisms, i.e., control of antibiotic transportation through membranes (reduction of porin permeability or increased efflux), modification of antibiotic targets, and enzymatic inactivation of the antibiotics. A = aminoglycosides; B = beta-lactams; C = chloramphenicol; F = fosfomycin; L = lincosamides; M = macrolides; MATE = multidrug and toxic compound extrusion; MFS = major facilitator superfamily; O = oxazolidinones; P = polymyxins; PBP = penicillin binding protein; Q = fluoroquinolones; R = rifamycins; RND = resistance-nodulation-division; S = diaminopyrimidines and sulfonamides; SMR = small multidrug resistance family; T = tetracyclines.