An error of omission; who is to blame? Antibiotyping for isolates of Acinetobacter spp. and its relevance for safety medical practice in hospital acquired wound and skin infections

R. Furau, A. R. Popa, C. Precup, I. R. Toma, I. Olariu, V. Toma, E. D. Popovici, C. Marcean, G. O. Furau, C. F. Ifrim

Abstract: Doctors aren't perfect, and medical malpractice laws do not require perfection. Mistakes can and will occur. But if a doctor's error falls below the applicable medical standard of care, the mistake may rise to the level of malpractice. But what if hospital standard of care isn't perfect? This study shows that doctors have to treat serious infections caused by multi-drug (MDR), extensively-drug (XDR) and even pan-drug resistant (PDR) bacteria without being completely informed about all germs' characteristics, data which are mandatory for a better medical decision. An example is Acinetobacter spp. which exhibit in the last two years an alarming percent of antimicrobial resistance: 71.16% MDR, 72.91% XDR and 1.63% PDR. Compared to European Minimal Inhibitory Concentration (MIC), the MIC values found in this study are by far higher, meaning that in a near future, if not already, antibiotics tratments would be futile: double values for cefepime, ceftazidime, minocycline and nalidixic acid; four times higher for amikacin, cefotaxime, gentamicin, levofloxacin, tetracycline, ticarcillin, tobramycin, ciprofloxacin, ertapenem, imipenem and meropenem; eight times higher for moxifloxacin, ofloxacin and tigecycline; ten times higher for colistin. Antibiotic sulfonamides and piperacillin-tazobactam are already completely useless. Only for aztreonam, ceftriaxone and cefuroxime the MICs values were under European minimum. There is no sensibility at all to cefoxitine. Three isolated were resistant to colistin, two of them in tracheo-bronchial secretion and one in wound secretion. Hospitals should provide better conditions for physicians to perform their medical act, to ensure everyone benefits.
Keywords: skin infections, antibiotic resistance, antibiotyping.