Acinetobacter baumannii colonises tracheal tubes, wounds and catheters readily in intensive care. A positive endotracheal aspirate or wound swab without clinical signs of infection often reflects colonisation, and treating it with colistin or other last-line drugs adds toxicity and resistance pressure without benefit.
Treat when there is a clinical syndrome: new infiltrate with fever and worsening oxygenation, bacteraemia, or a wound with signs of infection.
- Match every Acinetobacter isolate to a clinical syndrome before starting treatment.
- Treat a positive blood culture as significant and act promptly.
- Place colonised patients under contact precautions even when not treating them.
- Remove or change colonised devices where possible.
Why it matters
Unnecessary last-line antibiotics for colonisation drive the resistance that makes true infection untreatable.
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