Desafios clínicos e terapêuticos em infecções do sistema nervoso central por Acinetobacter baumannii multirresistente
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Resumo
Objetivo: Analisar os padrões de resistência, os desafios clínicos e as possibilidades de tratamento nas infecções do sistema nervoso central (SNC) causadas por Acinetobacter baumannii multirresistente. Revisão bibliográfica: As infecções por Acinetobacter baumannii multirresistentes presentes no SNC têm sido um grande desafio clínico, principalmente quando associadas a neurocirurgia ou traumatismo cranioencefálico. O tratamento atual para infecções do SNC causadas por A. baumannii multirresistente consiste na administração endovenosa combinada de agentes como: carbapenêmicos com ampicilina/sulbactam; carbapenêmicos associado à colistina; colistina com rifampicina e sulbactam; e tigeciclina associada à rifampicina e à ampicilina. Porém, devido à baixa permeabilidade desses agentes na barreira hematoencefálica, o uso de terapia antimicrobiana intratecal deve ser considerada e os principais agentes são: colistina, tigeciclina, gentamicina, amicacina e polimixina B. Considerações finais: O A. baumannii se tornou um dos patógenos mais desafiadores adquiridos em ambientes hospitalares. A dificuldade para penetração dos antimicrobianos na barreira hematoencefálica somada aos mecanismos de resistência desse microrganismo aos antimicrobianos dificultam o controle infeccioso, logo, favorecem uma alta taxa de mortalidade nas meningoencefalites. É essencial detectá-lo precocemente e adotar procedimentos rigorosos de controle de infecção. Ensaios clínicos são necessários para melhor assegurar a melhor escolha antimicrobiana e tempo de tratamento.
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