When do you use a carbapenem empirically to treat a patient with Acinetobacter infection?

Significant rates of Acinetobacter resistance to multiple classes of antimicrobial agents are a global concern. Mechanisms of resistance include bacterial production of beta-lactamases (i.e., carbapenemases), changes in porin channels, and alterations of target or cellular function due to mutations ...

I try very much to NOT start a carbapenem empirically, but really try for high-dose ampicillin/sulbactam. However, if the patient has MDR history, particularly with other ESBL gram negatives, I may consider starting with a carbapenem. It comes down a lot to the can-I-afford-to-be-wrong sick/not sick...