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Farmacoterapia das infeções por Acinetobacter baumannii
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Abstract(s)
O género Acinetobacter é constituído por várias espécies, sendo a maioria delas não patogénicas. Entre estas, destaca-se a bactéria Acinetobacter baumannii que é um agente responsável por infeções graves a nível hospitalar. Esta problemática surgiu há algumas décadas com o aumento da virulência e das complicações associadas ao seu tratamento.
A bactéria Acinetobacter baumannii causa diversas infeções como pneumonia, bacteremia, meningite, infeções da pele, tecidos moles e ossos e infeções urinárias. Os principais fatores de risco são doentes em unidades de cuidados intensivos, com comorbilidades e cujo sistema imunitário se encontra comprometido.
O elevado nível infecioso desta bactéria está associado não só aos seus fatores de virulência, como aos diversos mecanismos de resistência que fizeram com que este patógeno fosse listado como uma ameaça urgente sendo, segundo a Organização Mundial da Saúde, uma das bactérias prioritárias no desenvolvimento de novas terapêuticas. As resistências devem-se à inativação enzimática, bombas de efluxo, alterações da permeabilidade e alteração do alvo de ação.
Com base nas considerações anteriores, esta Dissertação tem como objetivo principal estudar a antibioterapia das infeções causadas por A. baumannii. Adicionalmente, pretende-se abordar os principais fatores de virulência, mecanismos de resistência, assim como novas abordagens terapêuticas. Em relação à metodologia, recorreu-se à análise documental de diversas fontes bibliográficas, privilegiando-se os artigos científicos.
As infeções provocadas por A. baumannii são tratadas com diversos antibióticos, como as penicilinas, carbapenemos e cefalosporinas. As alternativas terapêuticas são as polimixinas (isto é, a colistina e a polimixina B), a tigeciclina, o trimetoprim/sulfametoxazol e a ciprofloxacina. Ademais, salienta-se que nos últimos anos, as dificuldades de tratamento potenciaram a pesquisa de novas abordagens terapêuticas, como os anticorpos policlonais e monoclonais.
The Acinetobacter genus constituted by several species, most of which are non-pathogenic. Among these, the bacterium Acinetobacter baumannii stands out, which is an agent responsible for serious infections at hospital level. This problem arose a few decades ago with the increase in virulence and complications associated with its treatment. Acinetobacter baumannii causes various infections such as pneumonia, bacteraemia, meningitis, skin, soft tissue and bone infections and urinary infections. The main risk factors are patients in intensive care units, with comorbidities and whose immune system is compromised. The high infectious level of this bacterium is associated not only with its virulence factors, but also with the numerous resistance mechanisms that have caused this pathogen to be listed as an urgent threat and, according to the World Health Organization, one of the priority bacteria in the development of new therapies. Resistance is due to enzyme inactivation, efflux pumps, changes in permeability and changes in the target of action. Based on the previous considerations, the main objective of this Dissertation is to study the antibiotherapy of infections caused by A. baumannii. Additionally, it is intended to address the main virulence factors, resistance mechanisms, as well as new therapeutic approaches. Regarding the methodology, a documentary analysis of several bibliographic sources was performed, giving priority to scientific articles. Infections caused by A. baumannii are treated with various antibiotics, such as penicillins, carbapenems and cephalosporins. Therapeutic alternatives are polymyxins (i.e., colistin and polymyxin B), tigecycline, trimethoprim/sulfamethoxazole and ciprofloxacin. In addition, it should be noted that in recent years, treatment difficulties have encouraged research into new therapeutic approaches, such as polyclonal and monoclonal antibodies.
The Acinetobacter genus constituted by several species, most of which are non-pathogenic. Among these, the bacterium Acinetobacter baumannii stands out, which is an agent responsible for serious infections at hospital level. This problem arose a few decades ago with the increase in virulence and complications associated with its treatment. Acinetobacter baumannii causes various infections such as pneumonia, bacteraemia, meningitis, skin, soft tissue and bone infections and urinary infections. The main risk factors are patients in intensive care units, with comorbidities and whose immune system is compromised. The high infectious level of this bacterium is associated not only with its virulence factors, but also with the numerous resistance mechanisms that have caused this pathogen to be listed as an urgent threat and, according to the World Health Organization, one of the priority bacteria in the development of new therapies. Resistance is due to enzyme inactivation, efflux pumps, changes in permeability and changes in the target of action. Based on the previous considerations, the main objective of this Dissertation is to study the antibiotherapy of infections caused by A. baumannii. Additionally, it is intended to address the main virulence factors, resistance mechanisms, as well as new therapeutic approaches. Regarding the methodology, a documentary analysis of several bibliographic sources was performed, giving priority to scientific articles. Infections caused by A. baumannii are treated with various antibiotics, such as penicillins, carbapenems and cephalosporins. Therapeutic alternatives are polymyxins (i.e., colistin and polymyxin B), tigecycline, trimethoprim/sulfamethoxazole and ciprofloxacin. In addition, it should be noted that in recent years, treatment difficulties have encouraged research into new therapeutic approaches, such as polyclonal and monoclonal antibodies.
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Keywords
Acinetobacter baumannii Infeções Antibioterapia Mecanismos de resistência