Clinical Outcomes and Bacterial Characteristics of Carbapenem-Resistant Acinetobacter baumannii Among Patients from Different Global Regions.
carbapenem-resistant Acinetobacter baumannii
clinical impact
international epidemiology
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
20 Sep 2023
20 Sep 2023
Historique:
received:
15
06
2023
revised:
05
09
2023
accepted:
15
09
2023
medline:
22
9
2023
pubmed:
22
9
2023
entrez:
22
9
2023
Statut:
aheadofprint
Résumé
Carbapenem-resistant Acinetobacter baumannii (CRAb) is one of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb. In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis. Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs. 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases. CRAb infection types and clinical outcomes differed significantly across regions. While CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. #NCT03646227.
Sections du résumé
BACKGROUND
BACKGROUND
Carbapenem-resistant Acinetobacter baumannii (CRAb) is one of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.
METHODS
METHODS
In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis.
RESULTS
RESULTS
Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs. 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases.
CONCLUSIONS
CONCLUSIONS
CRAb infection types and clinical outcomes differed significantly across regions. While CG2 strains remained predominant, non-CG2 strains were associated with higher mortality.
CLINICALTRIALS.GOV
BACKGROUND
#NCT03646227.
Identifiants
pubmed: 37738153
pii: 7278825
doi: 10.1093/cid/ciad556
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03646227']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIAID NIH HHS
ID : R21 AI135522
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI104681
Pays : United States
Investigateurs
Souha S Kanj
(SS)
Fujie Zhang
(F)
Judith J Lok
(JJ)
Robert A Salata
(RA)
Martin Stryjewski
(M)
Valentina Di Castelnuovo
(V)
Jose Millan Oñate Gutierrez
(JM)
Eric Cober
(E)
Susan Richter
(S)
Deverick J Anderson
(DJ)
Beth Evans
(B)
Carol Hill
(C)
Heather R Cross
(HR)
Keri Baum
(K)
Rebekka Arias
(R)
Vance G Fowler
(VG)
Karen Ordoñez
(K)
Jesse T Jacob
(JT)
Linghua Li
(L)
Barry N Kreiswirth
(BN)
Claudia Manca
(C)
Liang Chen
(L)
Samit Desai
(S)
Erica Herc
(E)
Ezequiel Cordova
(E)
Maria Rioseco
(M)
Samuel Vilchez
(S)
Marisa L Sanchez
(ML)
Sandra Valderrama
(S)
Jairo Figueroa
(J)
Cesar A Arias
(CA)
An Q Dinh
(AQ)
Diane Panesso
(D)
Kirsten Rydell
(K)
Truc T Tran
(TT)
Fupin Hu
(F)
Jiachun Su
(J)
Jianping Jiang
(J)
Minggui Wang
(M)
Xiaogang Xu
(X)
Yang Yang
(Y)
Jose M Munita
(JM)
Maria Spencer
(M)
Thamer Alenazi
(T)
Robert A Bonomo
(RA)
Steven H Marshall
(SH)
Susan D Rudin
(SD)
Charles Huskins
(C)
Kerry Greenwood-Quaintance
(K)
Robin Patel
(R)
Suzannah Schmidt-Malan
(S)
Sara Revolinski
(S)
Glenn Wortmann
(G)
Robert C Kalayjian
(RC)
Gregory Weston
(G)
Belinda Ostrowsky
(B)
Gopi Patel
(G)
Daniel Eiras
(D)
Angela Kim
(A)
Julia Garcia-Diaz
(J)
Soraya Salcedo
(S)
John J Farrell
(JJ)
Zhengyin Liu
(Z)
Andrew Henderson
(A)
David L Paterson
(DL)
Qing Xie
(Q)
Keith S Kaye
(KS)
Hainv Gao
(H)
Yunsong Yu
(Y)
Mary Waters
(M)
Bettina C Fries
(BC)
Brandon Eilertson
(B)
Kalisvar Marimuthu
(K)
Oon Tek Ng
(OT)
Partha Pratim De
(P)
Kean Lee Chew
(K)
Nares Smitasin
(N)
Paul Ananth Tambyah
(PA)
Jason C Gallagher
(JC)
Anton Peleg
(A)
Marcel Leroi
(M)
Lanjuan Li
(L)
Yonghong Xiao
(Y)
Lauren Komarow
(L)
Lizhao Ge
(L)
Scott Evans
(S)
Todd McCarty
(T)
Henry F Chambers
(HF)
Omai B Garner
(OB)
Lilian M Abbo
(LM)
David van Duin
(D)
Ebbing Lautenbach
(E)
Jennifer H Han
(JH)
Yohei Doi
(Y)
Darren Wong
(D)
Blake Hanson
(B)
Jinnethe Reyes
(J)
Maria Virginia Villegas Botero
(MV)
Lorena Diaz
(L)
Federico Perez
(F)
Ritu Banerjee
(R)
Sorabh Dhar
(S)
Michael J Satlin
(MJ)
Lars F Westblade
(LF)
Zhiyong Zong
(Z)
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.