Multiple resistance amongst the bacteria genus Acinetobacter, and the species Acinetobacter baumannii in particular, is causing concern amongst microbiologists.
Recent surveillance studies report rates of multiresistance of around 30%, reports a review article in The Lancet Infectious Diseases, published online today.
Incidence of infections with the species have also increased significantly over the last thirty years with more invasive medical support to more sick patients meaning greater numbers are at risk.
Authors Professor Matthew Falagas and Dr Drosos Karageorgopoulos of the Alfa Institute of Biomedical Sciences in Greece advise strict hygiene compliance and detailed research into drug choice to prevent major outbreaks.
The bug has attracted widespread media attention recently with cases of infections being seen in military personnel returning from Iraq. In particular the multiresistant T strain, nicknamed "Iraqibacter", which is now being seen in UK hospitals after staff and patients have become infected through contact with soldiers.
"This strain is very virulent and there have been major outbreaks in Canada, Germany and now sadly in the UK so that is a worry and we have very few drugs to treat Acinetobacter," said Professor Peter Lambert, a professor of microbiology at Aston University in Birmingham.
Whilst Acinetobacter are found on the skin of 25 % of healthy adults, it is of serious threat when causing infections in hospitalised patients especially those that are critically ill. Affected patients tend to be older, those with serious underlying diseases, immune suppression, major trauma or burn injuries, have had invasive procedures (including indwelling catheters), mechanical ventilation support, extended hospital stay, and previous administration of antibiotics.
Carbapenems have long been used first line for Acinetobacter but resistance rates have risen substantially in some areas. In England, Wales and Northern Ireland for example, resistance to imipenem rose from 2% in 1994 to 12% in 2007.
Sulbactam has also been used successfully for treating serious Acinetobacter baumannii infections but its effectiveness against carbapenem-resistant isolates is falling.
Polymyxins and Minocycline are looking promising against the bacterium in small research studies, report the Lancet authors, but more clinical evidence is needed.
Meanwhile, the Health Protection Agency has launched a campaign to teach school children about prudent use of antibiotics and good hygiene.
"E-Bug", a European Commission sponsored project, developed by the HPA and European partners, will be run across schools in Europe from September 2009.
It is targeted at 9-11 and 12-15 year olds.
Dr Cliodna McNulty, who led on the development of the project, said: "Campaigns so far have been aimed at adults but we need to educate our future generation of adults and parents about the benefits of antibiotics and the problems that can arise through their misuse."