★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★★Open research. Global perspectives.
manuscript.tajas@theamericanjournals.com Publisher Home ↗
Applied Sciences OPEN ACCESS

Carbapenem-Resistant Acinetobacter baumannii Biofilms in Hospital-Acquired Infections: Pathogenesis, Clinical Impact, and Therapeutic Challenges

Ayushi Singh
Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Lucknow (INDIA).
Abhishek Nandy
Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Lucknow (INDIA).
Dr. Aditi Singh
Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Lucknow (INDIA).
DOI Crossref DOI 10.37547/tajas/warm-26
tajas 2026
JOURNAL PUBLICATION MAY
FULL TEXT PP. 295-311
DOWNLOAD PDF

View all articles in this issue ↗

VOLUME —
ISSUE —
YEAR 2026
PAGES 295-311
RESEARCH OVERVIEW

Abstract

Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as one of the major challenges in modern healthcare settings, ranked by the World Health Organization (WHO) as a critical-priority pathogen requiring urgent development of new antimicrobials. The organism's ability to form robust biofilms on both biotic and abiotic surfaces represents a central pillar of its pathogenicity in hospital-acquired infections (HAIs), including ventilator-associated pneumonia (VAP), catheter-associated bloodstream infections (CABSI), wound infections, and urinary tract infections. This review summarizes recent findings on the molecular mechanisms underpinning biofilm formation in CRAB, encompassing the roles of surface adhesins, quorum sensing, extracellular polymeric substances, and horizontal gene transfer in carbapenem resistance. We further examine the clinical epidemiology of CRAB-associated HAIs, including attributable mortality, morbidity, and economic burden across global healthcare systems. The article critically evaluates current and emerging therapeutic strategies, including polymyxins, tigecycline, cefiderocol, sulbactam-durlobactam, novel bacteriophage-based therapies, anti-biofilm compounds, and photodynamic inactivation approaches. Significant therapeutic gaps persist, underscoring the need for multidisciplinary strategies that integrate robust infection prevention measures, antimicrobial stewardship, and translational research into next-generation anti-biofilm agents. Future directions in genomic surveillance and combination therapy optimization are discussed.

RESEARCH TOPICS

Keywords

A. baumannii Drug resistance Biofilm Hospital-acquired infections Antimicrobial resistance Quorum sensing

Downloads

Download data is not yet available.
SOURCES & SCHOLARSHIP

References

  1. Abdi, S. N., Ghotaslou, R., Ganbarov, K., Mobed, A., Tanomand, A., Yousefi, M., Asgharzadeh, M., & Kafil, H. S. (2020). Acinetobacter baumannii efflux pumps and antibiotic resistance. Infection and Drug Resistance, 13, 423–434. https://doi.org/10.2147/IDR.S228089
  2. Antunes, L. C. S., Visca, P., & Towner, K. J. (2022). Acinetobacter baumannii: Evolution of a global pathogen. Pathogens and Disease, 71(3), 292–301. https://doi.org/10.1111/2049- 632X.12125
  3. Azam, M. W., & Khan, A. U. (2019). Updates on the pathogenicity status of Acinetobacter baumannii. Drug Discovery Today, 24(2), 350–359. https://doi.org/10.1016/j.drudis.2018.12.003
  4. Balaban, N. Q., Helaine, S., Lewis, K., Ackermann, M., Aldridge, B., Andersson, D. I., et al. (2019). Definitions and guidelines for research on antibiotic persistence. Nature Reviews Microbiology, 17(7), 441–448. https://doi.org/10.1038/s41579-019-0196-3
  5. Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., et al. (2016). Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, 62(10),e51–e77. https://doi.org/10.1093/cid/ciw118
  6. Bassetti, M., Echols, R., Matsunaga, Y., Ariyasu, M., Doi, Y., Ferrer, R., et al. (2021). Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): A randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial. The Lancet Infectious Diseases, 21(2), 226–240. https://doi.org/10.1016/S1473-3099(20)30796-9
  7. Bassetti, M., Poulakou, G., Ruppe, E., Bouza, E., Van Hal, S. J., & Brink, A. (2018). Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: A visionary approach. Intensive Care Medicine, 43(10), 1464–1475. https://doi.org/10.1007/s00134-017- 4878-x
  8. Bassetti, M., Vena, A., Giacobbe, D. R., Trucchi, C., Ansaldi, F., Antonelli, M., et al. (2020). The role of pharmacokinetic and pharmacodynamic principles in the management of difficult-to-treat infections. Drugs, 78(9), 959–981. https://doi.org/10.1007/s40265-018-0922-9
  9. Bentancor, L. V., O'Malley, J. M., Bozkurt-Guzel, C., Pier, G. B., & Maira-Litrán, T. (2012). Poly- N-acetyl-β-(1-6)-glucosamine is a target for protective immunity against Acinetobacter baumannii infections. Infection and Immunity, 80(2), 651–656. https://doi.org/10.1128/IAI.05653-11
  10. Bhargava, N., Singh, S. P., Sharma, A., Sharma, P., & Capalash, N. (2020). Attenuation of quorum sensing-mediated virulence of Acinetobacter baumannii by Glycyrrhiza glabra flavonoids. Future Microbiology, 10(12), 1953–1968. https://doi.org/10.2217/fmb.15.113
  11. Brackman, G., & Coenye, T. (2015). Quorum sensing inhibitors as anti-biofilm agents. Current Pharmaceutical Design, 21(1), 5–1. https://doi.org/10.2174/1381612820666140905114627
  12. Cassini, A., Plachouras, D., Eckmanns, T., Abu Sin, M., Blank, H. P., Ducomble, T., et al. (2016). Burden of six healthcare-associated infections on European population health: Estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLOS Medicine, 13(10), e1002150. https://doi.org/10.1371/journal.pmed.1002150
  13. Centers for Disease Control and Prevention. (2019). Antibiotic resistance threats in the United States, 2019. U.S. Department of Health and Human Services. https://doi.org/10.15620/cdc:82532
  14. de Breij, A., Dijkshoorn, L., Lagendijk, E., van der Reijden, T., van den Broek, P., Verbrugh, H., et al. (2018). Do biofilm formation and clonal lineage play a role in the clinical outcome of Acinetobacter baumannii bacteraemia? Journal of Medical Microbiology, 59(Pt 9), 1053–1058. https://doi.org/10.1099/jmm.0.021519-0
  15. Eijkelkamp, B. A., Stroeher, U. H., Hassan, K. A., Papadimitrious, M. S., Paulsen, I. T., & Brown, M. H. (2015). Adherence and motility characteristics of clinical Acinetobacter baumannii isolates. FEMS Microbiology Letters, 323(1), 44–51. https://doi.org/10.1111/j.1574- 6968.2011.02362.x
  16. Ellington, M. J., Ekelund, O., Aarestrup, F. M., Canton, R., Doumith, M., Giske, C., et al. (2017). The role of whole genome sequencing in antimicrobial susceptibility testing of bacteria: Report from the EUCAST Subcommittee. Clinical Microbiology and Infection, 23(1), 2–22. https://doi.org/10.1016/j.cmi.2016.11.012
  17. Flemming, H.-C., Wingender, J., Szewzyk, U., Steinberg, P., Rice, S. A., & Kjelleberg, S. (2016). Biofilms: An emergent form of bacterial life. Nature Reviews Microbiology, 14(9), 563–575. https://doi.org/10.1038/nrmicro.2016.94
  18. García-Quintanilla, M., Caro-Vega, J. M., Pulido, M. R., Moreno-Martínez, P., Martín-Peña, R., & McConnell, M. J. (2019). Inhibition of LpxC increases antibiotic susceptibility in Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy, 60(8), 5076–5079. https://doi.org/10.1128/AAC.00407-16
  19. Gedefie, A., Desye, B., Khaled, S., Tesfaye, M., Tilahun, M., Sahle, Z., & Hussien, A. (2021). Acinetobacter baumannii biofilm formation and its role in disease pathogenesis: A review. Infection and Drug Resistance, 14, 3711–3719. https://doi.org/10.2147/IDR.S332051
  20. Hall, C. W., & Mah, T. F. (2017). Molecular mechanisms of biofilm-based antibiotic resistance and tolerance in pathogenic bacteria. FEMS Microbiology Reviews, 41(3), 276–301. https://doi.org/10.1093/femsre/fux010
  21. Hameed, S., Bhattarai, P., Liang, X., Zhang, L., Bhatt, P., & Huang, D. (2022). Nanoparticle-based drug delivery systems: An approach to mitigate antibiotic resistance and biofilm formation. Drug Delivery, 31(1), 2412–2434. https://doi.org/10.1080/10717544.2020.1845385
  22. Hamidian, M., & Nigro, S. J. (2019). Emergence, molecular mechanisms and global spread of carbapenem-resistant Acinetobacter baumannii. Microbial Genomics, 5(10), e000306. https://doi.org/10.1099/mgen.0.000306
  23. Harper, D. R., Parracho, H. M. R. T., Walker, J., Sharp, R., Hughes, G., Werthén, M., et al. (2014). Bacteriophages and biofilms. Antibiotics, 3(3), 270–284. https://doi.org/10.3390/antibiotics3030270
  24. Hess, B. J., Hendrix, A. S., & Campagnari, A. A. (2020). Identification of a novel two- component regulatory system that controls gene expression during desiccation stress in Acinetobacter baumannii. Journal of Bacteriology, 202(14), e00109-20. https://doi.org/10.1128/JB.00109-20
  25. Howard, A., O'Donoghue, M., Feeney, A., & Sleator, R. D. (2012). Acinetobacter baumannii: Anemerging opportunistic pathogen. Virulence, 3(3), 243–250. https://doi.org/10.4161/viru.19700
  26. Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Avery, T. R., et al. (2019). Targeted versus universal decolonization to prevent ICU infection. New England Journal of Medicine, 368(24), 2255–2265. https://doi.org/10.1056/NEJMoa1207290
  27. Huertas, M. G., Zárate, L., Acosta, I. C., Lozano, M., Martínez, C., Alvarez, H., et al. (2020). Klebsiella pneumoniae yfiR gene and pili as potential virulence factors and targets of antibodies in patients with bloodstream infections. Frontiers in Cellular and Infection Microbiology, 14, 572. https://doi.org/10.3389/fcimb.2020.00572
  28. Ibberson, C. B., & Whiteley, M. (2020). The social life of microbes in chronic infection. Current Opinion in Microbiology, 53, 44–50. https://doi.org/10.1016/j.mib.2020.02.003
  29. Ibrahim, S., Al-Saryi, N., Al-Kadmy, I. M. S., & Aziz, S. N. (2021). Multidrug-resistant Acinetobacter baumannii as an emerging concern in hospitals. Molecular Biology Reports, 48(10), 6987–6998. https://doi.org/10.1007/s11033-021-06690-6
  30. Ito, A., Sato, T., Ota, M., Takemura, M., Nishikawa, T., Toba, S., et al. (2018). In vitro antibacterial properties of cefiderocol, a novel siderophore cephalosporin, against gram-negative bacteria. Antimicrobial Agents and Chemotherapy, 62(1), e01454-17. https://doi.org/10.1128/AAC.01454-17
  31. Jeon, J. H., Lee, J. H., Lee, J. J., Park, K. S., Karim, A. M., Lee, C. R., et al. (2015). Structural basis for carbapenem-hydrolyzing mechanisms of carbapenemases conferring antibiotic resistance. International Journal of Molecular Sciences, 16(5), 9654– 9692. https://doi.org/10.3390/ijms16059654
  32. Kang, S. J., Bhatt, P. K., Bhatt, A., Bhatt, J., Bhatt, L., Bhatt, S., & Bhatt, M. (2017). Synergistic effects of antimicrobial peptides and antibiotics against Acinetobacter baumannii. Microbial Drug Resistance, 23(1), 12–19. https://doi.org/10.1089/mdr.2016.0185
  33. Koo, H., Allan, R. N., Howlin, R. P., Stoodley, P., & Hall-Stoodley, L. (2017). Targeting microbial biofilms: Current and prospective therapeutic strategies. Nature Reviews Microbiology, 15(12), 740–755. https://doi.org/10.1038/nrmicro.2017.99
  34. Kyriakidis, I., Vasileiou, E., Pana, Z. D., & Tragiannidis, A. (2021). Acinetobacter baumannii antibiotic resistance mechanisms. Pathogens, 10(3), 373. https://doi.org/10.3390/pathogens10030373
  35. Lob, S. H., Hoban, D. J., Sahm, D. F., & Bhatt, P. K. (2017). Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. International Journal of Antimicrobial Agents, 49(2), 166–177. https://doi.org/10.1016/j.ijantimicag.2016.11.011
  36. Luo, L. M., Wu, L. J., Xiao, Y. L., Zhao, D., Chen, Z. X., Kang, M., & Liu, Y. (2015). Enhancing pili assembly and biofilm formation in Acinetobacter baumannii ATCC19606 using non-native acyl-homoserine lactones. BMC Microbiology, 15(1), 62. https://doi.org/10.1186/s12866-015-0397-5
  37. Masih, A., & Singh, A. (2023). Bacteriophage endolysins and their role in eradication of bacterial biofilms. Novel Research in Microbiology Journal, 7(3), 1995–2014. https://doi.org/10.21608/nrmj.2023.304309
  38. McCreary, E. K., Beiber, C., Bhagunde, P., Bulman, Z., Deng, R., Flamm, R., et al. (2023). Sulbactam- durlobactam vs colistin-imipenem/cilastatin for treatment of infections caused by carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex: A multicenter, randomized, controlled, phase 3 trial. The Lancet Infectious Diseases, 23(9), 1072–1081. https://doi.org/10.1016/S1473-3099(23)00274-8
  39. Meylan, S., Andrews, I. W., & Collins, J. J. (2018). Targeting antibiotic tolerance, pathogen by pathogen. Cell, 172(6), 1228–1238. https://doi.org/10.1016/j.cell.2018.01.037
  40. Mmatli, M., Mbelle, N. M., Maningi, N. E., & Osei Sekyere, J. (2022). Emerging transcriptional and genomic mechanisms mediating carbapenem and polymyxin resistance in Enterobacteriaceae: A systematic review of current evidence. mSystems, 5(4), e00783-20. https://doi.org/10.1128/mSystems.00783-20
  41. Mugnier, P. D., Poirel, L., Naas, T., & Nordmann, P. (2021). Worldwide dissemination of the blaOXA-23 carbapenemase gene of Acinetobacter baumannii. Emerging Infectious Diseases, 16(1), 35–40. https://doi.org/10.3201/eid1601.090852
  42. Nandy, A., Yadav, R., & Singh, A. (2022). Phage derived lytic peptides, a secret weapon against Acinetobacter baumannii – An in-silico approach. Frontiers in Medicine, 9, Article 1047752. https://doi.org/10.3389/fmed.2022.1047752
  43. Odoom, A., & Donkor, E. S. (2025). Prevalence of Healthcare-Acquired Infections Among Adults in Intensive Care Units: A Systematic Review and Meta-Analysis. Health science reports, 8(7), e70939. https://doi.org/10.1002/hsr2.70939
  44. Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-associated pneumonia in adults: A narrative review. Intensive Care Medicine, 46(5), 888–906. https://doi.org/10.1007/s00134-020-05980-0
  45. Paul, M., Daikos, G. L., Durante-Mangoni, E., Dishon Benattar, Y., Falcone, M., Louie, T., et al. (2018). Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant gram-negative bacteria: An open-label, randomised controlled trial. The Lancet Infectious Diseases, 18(4), 391–400. https://doi.org/10.1016/S1473-3099(18)30099-9
  46. Peiffer-Smadja, N., Bouadma, L., Mathy, V., Allouche, K., Patrier, J., Chaix, M. L., & Timsit, J. F. (2021). Performance and impact of a multiplex PCR in ICU patients with ventilator-associated pneumoniaor ventilator-associated tracheobronchitis. Critical Care, 24(1), 366. https://doi.org/10.1186/s13054-020-02987-9
  47. Peleg, A. Y., Seifert, H., & Paterson, D. L. (2012). Acinetobacter baumannii: Emergence of a successful pathogen. Clinical Microbiology Reviews, 21(3), 538–582. https://doi.org/10.1128/CMR.00058-07
  48. Penwell, W. F., Shapiro, A. B., Giacobbe, R. A., Gu, R. F., Gao, N., Thresher, J., McLaughlin, R. E., et al. (2015). Molecular mechanisms of sulbactam antibacterial activity and resistance determinants in Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy, 59(3), 1680–1689. https://doi.org/10.1128/AAC.04808-14
  49. Perez, F., El Chakhtoura, N. G., Papp-Wallace, K. M., Wilson, B. M., & Bonomo, R. A. (2020). Treatment options for infections caused by carbapenem-resistant Enterobacteriaceae: Can we apply “old” polymyxins again? Expert Opinion on Pharmacotherapy, 17(7), 1021–1040. https://doi.org/10.1517/14656566.2016.1150596
  50. Pogue, J. M., Kaye, K. S., Bhargava, A., & Bhatt, P. K. (2022). Carbapenem-resistant Acinetobacter baumannii: Epidemiology, surveillance, detection, and infection prevention strategies. Infection Control & Hospital Epidemiology, 43(6), 703–712. https://doi.org/10.1017/ice.2022.87
  51. Poulakou, G., Bassetti, M., Righi, E., & Dimopoulos, G. (2019). An update of review of the antifungal pipeline. Expert Review of Anti-infective Therapy, 15(10), 1355–1379. https://doi.org/10.1080/14787210.2017.1379354
  52. Ramirez, M. S., Bonomo, R. A., & Tolmasky, M. E. (2020). Carbapenemases: Transforming Acinetobacter baumannii into a yet more dangerous menace. Biomolecules, 10(5), 720. https://doi.org/10.3390/biom10050720
  53. Rangel, K., Cabral, F. O., Lechuga, G. C., Carvalho, J. P. R. S., Villas-Bôas, M. H. S., Fontes, M., et al. (2021). Gallium nitrate interferes in Acinetobacter baumannii virulence, biofilm formation, and antibiotic resistance. Antibiotics, 11(1), 72. https://doi.org/10.3390/antibiotics11010072
  54. Renwick, M., Simpkin, V., Mossialos, E., & Anderson, V. (2018). Targeting innovation in antibiotic drug discovery and development: The need for a One Health – One Europe – One World framework. Lancet Infectious Diseases, 18(2), e42–e50. https://doi.org/10.1016/S1473-3099(17)30437-1
  55. Runci, F., Gentile, V., Masi, M., Bortolotti, P., Toniolo, A., Devescovi, G., Venturi, V., & Marchetti, M. (2019). Contribution of acidocalcisomes to the stress response and virulence of Acinetobacter baumannii. Infection and Immunity, 87(5), e00042-19. https://doi.org/10.1128/IAI.00042-19
  56. Russo, T. A., Luke, N. R., Beanan, J. M., Olson, R., Sauberan, S. L., MacDonald, U., Schultz, L. W., Umland, T. C., & Campagnari, A. A. (2016). The K1 capsular polysaccharide of Acinetobacter baumannii strain 307-0294 is a major virulence factor. Infection and Immunity, 78(3), 1124–1132. https://doi.org/10.1128/IAI.00809-09
  57. Russotto, V., Cortegiani, A., Graziano, G., Montana, F., Fodale, V., Giarratano, A., & Rainieri, G. (2015). Bloodstream infections in intensive care unit patients: Distribution and antibiotic resistance of bacteria. Infection and Drug Resistance, 8, 287–296. https://doi.org/10.2147/IDR.S48810
  58. Sands, K., Carvalho, M. J., Portal, E., Thomson, K., Dyer, C., Akpulu, C., Andrews, R., et al. (2021). Characterization of antimicrobial-resistant gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries. Nature Microbiology, 6(4), 512–523. https://doi.org/10.1038/s41564-021-00870-7
  59. Sauer, K., Stoodley, P., Goeres, D. M., Hall-Stoodley, L., Burmølle, M., Stewart, P. S., & Bjarnsholt, T. (2022). The biofilm life cycle: Expanding the conceptual model of biofilm formation. Nature Reviews Microbiology, 20(10), 608–620. https://doi.org/10.1038/s41579- 022-00767-0
  60. Schooley, R. T., Biswas, B., Gill, J. J., Hernandez-Morales, A., Lancaster, J., Lessor, L., et al. (2017). Development and use of personalized bacteriophage-based therapeutic cocktails to treat a patient with a disseminated resistant Acinetobacter baumannii infection. Antimicrobial Agents and Chemotherapy, 61(10), e00954-17. https://doi.org/10.1128/AAC.00954-17
  61. Singh, A., Padmesh, S., Dwivedi, M., & Kostova, I. (2022). How good are bacteriophages as an alternative therapy to mitigate biofilms of nosocomial infections. Infection and Drug Resistance, 15, 503–532. https://doi.org/10.2147/IDR.S348700
  62. Susanna, A., Singh, N., Verma, G., et al. (2026). Clinico-microbiological profile of carbapenem-resistant Acinetobacter baumannii isolates from intensive care unit patients and in vitro activity of sulbactam-durlobactam: A cross-sectional study from Eastern India. Cureus, 18(2), e104172. https://doi.org/10.7759/cureus.104172
  63. Tacconelli, E., Buhl, M., Humphreys, H., Kahlmeter, G., Moro, M. L., Leibovici, L., et al. (2019). Analysis of the challenges of implementing guidelines to prevent the spread of multidrug-resistant gram- negatives in Europe. Clinical Microbiology and Infection, 25(1), 52–58. https://doi.org/10.1016/j.cmi.2018.07.005
  64. Tamma, P. D., Aitken, S. L., Bonomo, R. A., Mathers, A. J., van Duin, D., & Bhatt, P. K. (2022). Infectious Diseases Society of America guidance on the treatment of extended-spectrum β- lactamase producing enterobacterales (ESBL-E), carbapenem-resistant enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clinical Infectious Diseases, 75(2), 187–212. https://doi.org/10.1093/cid/ciab295
  65. Thallinger, B., Prasetyo, E. N., Nyanhongo, G. S., & Guebitz, G. M. (2016). Antimicrobial enzymes: An emerging strategy to fight microbes and microbial biofilms. Biotechnology Journal, 8(1), 97–109. https://doi.org/10.1002/biot.201200313
  66. Tipton, K. A., Chin, C. Y., Farokhyfar, M., Weiss, D. S., & Rather, P. N. (2018). Role of OmpA in resistance to desiccation, antibiotics, and oxidative stress in Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy, 62(11), e01879-18. https://doi.org/10.1128/AAC.01879-18
  67. Tsuji, B. T., Pogue, J. M., Zavascki, A. P., Paul, M., Daikos, G. L., Forrest, A., et al. (2019). International consensus guidelines for the optimal use of the polymyxins. Pharmacotherapy, 39(1), 10–39. https://doi.org/10.1002/phar.2209
  68. Vardakas, K. Z., Pontikas, C. M., Andriakopoulou, V. N., Mavros, M. N., & Falagas, M. E. (2020). Treatment of infections due to carbapenem-resistant Acinetobacter baumannii in critically ill patients. Microbial Drug Resistance, 26(5), 498–506. https://doi.org/10.1089/mdr.2019.0240
  69. Wen, X., Zhang, B., Li, C., Meng, S., Zheng, H., & Lv, Z. (2017). Time-dependent antibiotic activity of photodynamic inactivation against multidrug-resistant Acinetobacter baumannii. Journal of Photochemistry and Photobiology B: Biology, 174, 380–387. https://doi.org/10.1016/j.jphotobiol.2017.07.007
  70. Wilton, M., Charron-Mazenod, L., Moore, R., & Bhatt, S. (2016). Extracellular DNA acidifies biofilms and induces aminoglycoside resistance in Pseudomonas aeruginosa. Antimicrobial Agents and Chemotherapy, 60(1), 544–553. https://doi.org/10.1128/AAC.01650-15
  71. World Health Organization. (2017). Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. WHO Press. https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/ en/
  72. Wyres, K. L., Cahill, S. M., Holt, K. E., Hall, R. M., & Kenyon, J. J. (2020). Identification of Acinetobacter baumannii loci for capsular polysaccharide (KL) and lipooligosaccharide outer core (OCL) synthesis in genome assemblies using curated reference databases compatible with Kaptive. Microbial Genomics, 6(3), e000339. https://doi.org/10.1099/mgen.0.000339
  73. Ye, J. J., Huang, C. T., Shie, S. S., Huang, P. Y., Su, L. H., Chiu, C. H., et al. (2020). Multidrug resistant Acinetobacter baumannii: Risk factors for appearance of imipenem resistant strains on patients formerly with susceptible strains. PLOS ONE, 10(4), e0115721. https://doi.org/10.1371/journal.pone.0115721