Editorial Commentary: Rifampicin Plus Colistin in the Era of Extensively Drug-Resistant Acinetobacter baumannii Infections

Abstract

employthistherapyremainsunknownand resistance may develop on therapy [4, 5]. Approaching the dilemma from an alternate angle, experimental models of infection reveal that rifampicin monotherapy has activity versus XDR Acb, although high-level resistance develops early during monotherapy, presumably through overexpression of efflux pumps or rpoB gene mutation. The combination of colistin plus rifampicin has been shown to prevent the development of resistant mutants and to be synergistic versus a number of Acb isolates, with available in vitro and in vivo datasuggestingsafetyand efficacy.Whether enhanced bacterial killing translates into improved outcomes for critically ill patients infected with XDR Acb nonsusceptible to carbapenems is the focus of the trial by Durante-Mangoni et al in this issue of Clinical Infectious Diseases [6].