Analysis of risk factors and different treatments for infections caused by carbapenem-resistant Acinetobacter baumannii in Shaanxi, China.
Humans
Acinetobacter baumannii
/ drug effects
Carbapenems
/ therapeutic use
Acinetobacter Infections
/ drug therapy
Risk Factors
China
/ epidemiology
Male
Female
Retrospective Studies
Anti-Bacterial Agents
/ therapeutic use
Middle Aged
Aged
Adult
Phylogeny
Microbial Sensitivity Tests
Whole Genome Sequencing
Molecular Epidemiology
Drug resistance
Molecular epidemiology
Mortality
Prognosis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
09 Oct 2024
09 Oct 2024
Historique:
received:
15
01
2024
accepted:
01
10
2024
medline:
10
10
2024
pubmed:
10
10
2024
entrez:
9
10
2024
Statut:
epublish
Résumé
The global threat of Carbapenem-resistant Acinetobacter baumannii (CRAB) has intensified as resistance to carbapenems continues to rise in recent decades. We aimed to explore risk factors, molecular epidemiology, and antimicrobial therapy of CRAB infection. The clinical data of 110 patients infected with A. baumannii from December 2021 to December 2022 were retrospectively analyzed. Patients were divided into a carbapenem-resistance group (55 patients) and carbapenem-sensitive group (CSAB; 55 patients) based on resistance to carbapenem, and the risk factors of patients infected with CRAB were analyzed. Fifty-five patients with CRAB infection who received antimicrobial therapy were divided into a combination therapy group (45 patients) and a monotherapy group (10 patients), and differences between the two groups were compared. Whole-genome sequencing analysis was performed to assess resistance genes. Phylogenetic analysis was performed to explore the characteristics of CRAB isolates. Among the total 110 patients, the rate of poor prognosis in the CRAB group was 43.6% (24/55). Mechanical ventilation (odds ratio [OR] = 5.364, 95% confidence interval [CI] 1.462-19.679, P = 0.011) and puncture (OR = 19.935, 95% CI 1.261-315.031, P = 0.012) were independent risk factors for CRAB infection. Of 55 patients in the antimicrobial regimen study, 45 received combination therapy (including dual, triple, or quadruple antibiotic therapy) and 10 received monotherapy. Univariate analysis revealed significant differences between the combination group and monotherapy group for admission to the intensive care unit and wound infection (P < 0.05). The CRAB strains of 26 patients taking carbapenem-based combination therapy were mainly ST208, ST1968, and ST195, among which patients with ST1968 strains had higher 28-day mortality. Furthermore, the bla Mortality was significantly higher in patients infected with CRAB than with CSAB. Mechanical ventilation and puncture were independent risk factors in predicting CRAB infections. The distribution of CRAB was dominated by ST208, ST1968, and ST195, among which patients with ST1968 had higher 28-day mortality. The bla
Sections du résumé
BACKGROUND
BACKGROUND
The global threat of Carbapenem-resistant Acinetobacter baumannii (CRAB) has intensified as resistance to carbapenems continues to rise in recent decades. We aimed to explore risk factors, molecular epidemiology, and antimicrobial therapy of CRAB infection.
METHODS
METHODS
The clinical data of 110 patients infected with A. baumannii from December 2021 to December 2022 were retrospectively analyzed. Patients were divided into a carbapenem-resistance group (55 patients) and carbapenem-sensitive group (CSAB; 55 patients) based on resistance to carbapenem, and the risk factors of patients infected with CRAB were analyzed. Fifty-five patients with CRAB infection who received antimicrobial therapy were divided into a combination therapy group (45 patients) and a monotherapy group (10 patients), and differences between the two groups were compared. Whole-genome sequencing analysis was performed to assess resistance genes. Phylogenetic analysis was performed to explore the characteristics of CRAB isolates.
RESULTS
RESULTS
Among the total 110 patients, the rate of poor prognosis in the CRAB group was 43.6% (24/55). Mechanical ventilation (odds ratio [OR] = 5.364, 95% confidence interval [CI] 1.462-19.679, P = 0.011) and puncture (OR = 19.935, 95% CI 1.261-315.031, P = 0.012) were independent risk factors for CRAB infection. Of 55 patients in the antimicrobial regimen study, 45 received combination therapy (including dual, triple, or quadruple antibiotic therapy) and 10 received monotherapy. Univariate analysis revealed significant differences between the combination group and monotherapy group for admission to the intensive care unit and wound infection (P < 0.05). The CRAB strains of 26 patients taking carbapenem-based combination therapy were mainly ST208, ST1968, and ST195, among which patients with ST1968 strains had higher 28-day mortality. Furthermore, the bla
CONCLUSIONS
CONCLUSIONS
Mortality was significantly higher in patients infected with CRAB than with CSAB. Mechanical ventilation and puncture were independent risk factors in predicting CRAB infections. The distribution of CRAB was dominated by ST208, ST1968, and ST195, among which patients with ST1968 had higher 28-day mortality. The bla
Identifiants
pubmed: 39385067
doi: 10.1186/s12879-024-10036-5
pii: 10.1186/s12879-024-10036-5
doi:
Substances chimiques
Carbapenems
0
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1130Subventions
Organisme : the Natural Science Basic Research Program of Shaanxi
ID : 2022JQ-974
Informations de copyright
© 2024. The Author(s).
Références
Hamidian M, Nigro SJ. Emergence, molecular mechanisms and global spread of carbapenem-resistant Acinetobacter baumannii. Microb Genom. 2019;5:e000306.
pubmed: 31599224
pmcid: 6861865
Harding CM, Hennon SW, Feldman MF. Uncovering the mechanisms of Acinetobacter baumannii virulence. Nat Rev Microbiol. 2018;16:91–102.
pubmed: 29249812
doi: 10.1038/nrmicro.2017.148
Ramirez MS, Bonomo RA, Tolmasky ME, Carbapenemases. Transforming Acinetobacter baumannii into a yet more dangerous menace. Biomolecules. 2020;10(5):720.
pubmed: 32384624
pmcid: 7277208
doi: 10.3390/biom10050720
Di Venanzio G, Flores-Mireles AL, Calix JJ, Haurat MF, Scott NE, Palmer LD, et al. Urinary tract colonization is enhanced by a plasmid that regulates uropathogenic Acinetobacter baumannii chromosomal genes. Nat Commun. 2019;10(1):2763.
pubmed: 31235751
pmcid: 6591400
doi: 10.1038/s41467-019-10706-y
Gu Y, Zhang W, Lei J, Zhang L, Hou X, Tao J, et al. Molecular epidemiology and carbapenem resistance characteristics of Acinetobacter baumannii causing bloodstream infection from 2009 to 2018 in northwest China. Front Microbiol. 2022;22:983–963.
Rando E, Segala FV, Vargas J, Seguiti C, De Pascale G, Murri R, et al. Cefiderocol for severe carbapenem-resistant A. Baumannii Pneumonia: towards the comprehension of its place in Therapy. Antibiot (Basel). 2021;11(1):3.
doi: 10.3390/antibiotics11010003
Livermore DM, Hill RL, Thomson H, Charlett A, Turton JF, Pike R, et al. Antimicrobial treatment and clinical outcome for infections with carbapenem- and multiply-resistant Acinetobacter baumannii around London. Int J Antimicrob Agents. 2010;35:19–24.
pubmed: 19910162
doi: 10.1016/j.ijantimicag.2009.09.014
Tal-Jasper R, Katz DE, Amrami N, Ravid D, Avivi D, Zaidenstein R, et al. Clinical and Epidemiological Significance of Carbapenem Resistance in Acinetobacter baumannii infections. Antimicrob Agents Chemother. 2016;60:3127–31.
pubmed: 26883694
pmcid: 4862462
doi: 10.1128/AAC.02656-15
Du X, Xu X, Yao J, Deng K, Chen S, Shen Z, et al. Predictors of mortality in patients infected with carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis. Am J Infect Control. 2019;47:1140–5.
pubmed: 31003750
doi: 10.1016/j.ajic.2019.03.003
Gu Y, Jiang Y, Zhang W, Yu Y, He X, Tao J, et al. Risk factors and outcomes of bloodstream infections caused by Acinetobacter baumannii: a case-control study. Diagn Microbiol Infect Dis. 2021;99:115229.
pubmed: 33161239
doi: 10.1016/j.diagmicrobio.2020.115229
Ng TM, Teng CB, Lye DC, Apisarnthanarak A. A multicenter case-case control study for risk factors and outcomes of extensively drug-resistant Acinetobacter baumannii bacteremia. Infect Control Hosp Epidemiol. 2014;35:49–55.
pubmed: 24334798
doi: 10.1086/674387
Niu T, Xiao T, Guo L, Yu W, Chen Y, Zheng B, et al. Retrospective comparative analysis of risk factors and outcomes in patients with carbapenem-resistant Acinetobacter baumannii bloodstream infections: cefoperazone-sulbactam associated with resistance and tigecycline increased the mortality. Infect Drug Resist. 2018;11:2021–30.
pubmed: 30464544
pmcid: 6208797
doi: 10.2147/IDR.S169432
Liu Y, Wang Q, Zhao C, Chen H, Li H, Wang H, et al. Prospective multi-center evaluation on risk factors, clinical characteristics and outcomes due to carbapenem resistance in Acinetobacter baumannii complex bacteraemia: experience from the Chinese Antimicrobial Resistance Surveillance of Nosocomial infections (CARES) network. J Med Microbiol. 2020;69:949–59.
pubmed: 32584215
doi: 10.1099/jmm.0.001222
Russo A, Bassetti M, Ceccarelli G, Carannante N, Losito AR, Bartoletti M, et al. Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: clinical features, therapy and outcome from a multicenter study. J Infect. 2019;79:130–8.
pubmed: 31145911
doi: 10.1016/j.jinf.2019.05.017
Chen F, Wang L, Wang M, Xie Y, Xia X, Li X, et al. Genetic characterization and in vitro activity of antimicrobial combinations of multidrug-resistant Acinetobacter baumannii from a general hospital in China. Oncol Lett. 2018;15:2305–15.
pubmed: 29434938
Clinical and Laboratory Standards. Institute. Performance standards for Antimicrobial susceptibility testing: 32nd edition. Wayne: CLSI; 2022.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–81.
pubmed: 21793988
doi: 10.1111/j.1469-0691.2011.03570.x
Phillippy AM, Wick RR, Judd LM, Gorrie CL, Holt KE. Unicycler: resolving bacterial genome assemblies from short and long sequencing reads. PLoS Comput Biol. 2017;13:e1005595.
doi: 10.1371/journal.pcbi.1005595
Gurevich A, Vyahhi SV, Tesler N. QUAST: quality assessment tool for genome assemblies. Bioinformatics. 2013;29:1072–5.
pubmed: 23422339
pmcid: 3624806
doi: 10.1093/bioinformatics/btt086
Zankari E, Hasman H, Cosentino S, Vestergaard M, Rasmussen S, Lund O, et al. Identification of acquired antimicrobial resistance genes. J Antimicrob Chemother. 2012;67:2640–4.
pubmed: 22782487
pmcid: 3468078
doi: 10.1093/jac/dks261
Jolley KA, Bray JE, Maiden MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res. 2018;3:124.
pubmed: 30345391
pmcid: 6192448
doi: 10.12688/wellcomeopenres.14826.1
Seemann T. Prokka: rapid prokaryotic genome annotation. Bioinformatics. 2014;30:2068–9.
pubmed: 24642063
doi: 10.1093/bioinformatics/btu153
Tonkin-Hill G, MacAlasdair N, Ruis C, Weimann A, Horesh G, Lees JA, et al. Producing polished prokaryotic pangenomes with the Panaroo pipeline. Genome Biol. 2020;21:180.
pubmed: 32698896
pmcid: 7376924
doi: 10.1186/s13059-020-02090-4
Letunic I, Bork P. Interactive tree of life (iTOL) v5: an online tool for phylogenetic tree display and annotation. Nucleic Acids Res. 2021;49:W293–6.
pubmed: 33885785
pmcid: 8265157
doi: 10.1093/nar/gkab301
Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18:318–27.
pubmed: 29276051
doi: 10.1016/S1473-3099(17)30753-3
Antunes LCS, Visca P, Towner KJ. Acinetobacter baumannii: Evolution of a global pathogen. Pathog Dis. 2014;71:292–301.
pubmed: 24376225
doi: 10.1111/2049-632X.12125
Zhou H, Yao Y, Zhu B, Ren D, Yang Q, Fu Y, et al. Risk factors for acquisition and mortality of multidrug-resistant Acinetobacter baumannii bacteremia: a retrospective study from a Chinese hospital. Med (Baltim). 2019;98:e14937.
doi: 10.1097/MD.0000000000014937
Chuang YC, Cheng A, Sun HY, Wang JT, Chen YC, Sheng WH, et al. Microbiological and clinical characteristics of Acinetobacter baumannii bacteremia: implications of sequence type for prognosis. J Infect. 2019;78:106–12.
pubmed: 30308215
doi: 10.1016/j.jinf.2018.10.001
Vijayakumar S, Mathur P, Kapil A, Das BK, Ray P, Gautam V, et al. Molecular characterization & epidemiology of carbapenem-resistant Acinetobacter baumannii collected across India. Indian J Med Res. 2019;149:240–6.
pubmed: 31219089
pmcid: 6563728
doi: 10.4103/ijmr.IJMR_2085_17
Anggraini D, Santosaningsih D, Endraswari PD, Jasmin N, Siregar FM, Hadi U, et al. Multicenter Study of the risk factors and outcomes of Bloodstream infections caused by Carbapenem-Non-susceptible Acinetobacter baumannii in Indonesia. Trop Med Infect Dis. 2022;7:161.
pubmed: 36006253
pmcid: 9412432
doi: 10.3390/tropicalmed7080161
Girmenia C, Rossolini GM, Piciocchi A, Bertaina A, Pisapia G, Pastore D, et al. Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients: a nationwide retrospective survey from Italy. Bone Marrow Transpl. 2015;50:282–8.
doi: 10.1038/bmt.2014.231
Agyeman AA, Bergen PJ, Rao GG, Nation RL, Landersdorfer CB. A systematic review and meta-analysis of treatment outcomes following antibiotic therapy among patients with carbapenem-resistant Klebsiella pneumoniae infections. Int J Antimicrob Agents. 2020;55:105833.
pubmed: 31730892
doi: 10.1016/j.ijantimicag.2019.10.014
Chen CH, Lin LC, Chang YJ, Chen YM, Chang CY, Huang CC. Infection control programs and antibiotic control programs to limit transmission of multi-drug resistant Acinetobacter baumannii infections; evolution of old problems and new challenges for institutes. Int J Environ Res Public Health. 2015;12:8871–82.
pubmed: 26264006
pmcid: 4555253
doi: 10.3390/ijerph120808871
Bartal C, Rolston KVI, Nesher L. Carbapenem-resistant Acinetobacter baumannii: colonization, infection and current treatment options. Infect Dis Ther. 2022;11(2):683–94.
pubmed: 35175509
pmcid: 8960525
doi: 10.1007/s40121-022-00597-w
Batirel A, Balkan II, Karabay O, Agalar C, Akalin S, Alici O, et al. Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections. Eur J Clin Microbiol Infect Dis. 2014;33:1311–22.
pubmed: 24532009
doi: 10.1007/s10096-014-2070-6
Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother. 2014;58:2322–8.
pubmed: 24514083
pmcid: 4023796
doi: 10.1128/AAC.02166-13
Tumbarello M, Trecarichi EM, De Rosa FG, Giannella M, Giacobbe DR, Bassetti M, et al. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study. J Antimicrob Chemother. 2015;70:2133–43.
pubmed: 25900159
doi: 10.1093/jac/dkv086
Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012;55:943–50.
pubmed: 22752516
doi: 10.1093/cid/cis588
Shi X, Wang H, Wang X, Jing H, Duan R, Qin S, et al. Molecular characterization and antibiotic resistance of Acinetobacter baumannii in cerebrospinal fluid and blood. PLoS ONE. 2021;16(2):e0247418.
pubmed: 33617547
pmcid: 7899338
doi: 10.1371/journal.pone.0247418
Jiang M, Zhang Z, Zhao S. Epidemiological characteristics and drug resistance analysis of multidrug-resistant Acinetobacter baumannii in a China hospital at a certain time. Pol J Microbiol. 2014;63(3):275–81.
pubmed: 25546937
doi: 10.33073/pjm-2014-037
Yazdansetad S, Najari E, Ghaemi EA, Javid N, Hashemi A, Ardebili A. Carbapenem-resistant Acinetobacter baumannii isolates carrying bla
pubmed: 30763760
doi: 10.1016/j.jgar.2018.12.011
Ruan Z, Chen Y, Jiang Y, Zhou H, Zhou Z, Fu Y, et al. Wide distribution of CC92 carbapenem-resistant and OXA-23-producing Acinetobacter baumannii in multiple provinces of China. Int J Antimicrob Agents. 2013;42:322–8.
pubmed: 23988720
doi: 10.1016/j.ijantimicag.2013.06.019
Chen Y, Gao J, Zhang H, Ying C. Spread of the bla
pubmed: 28220115
pmcid: 5292404
Espinal P, Macià MD, Roca I, Gato E, Ruíz E, Fernández-Cuenca F, et al. First report of an OXA-23 carbapenemase-producing Acinetobacter baumannii clinical isolate related to Tn2006 in Spain. Antimicrob Agents Chemother. 2013;57:589–91.
pubmed: 23070166
pmcid: 3535974
doi: 10.1128/AAC.01157-12
Guerrero-Lozano I, Fernández-Cuenca F, Galán-Sánchez F, Egea P, Rodríguez-Iglesias M, Pascual Á. Description of the OXA-23 β-lactamase gene located within Tn2007 in a clinical isolate of Acinetobacter baumannii from Spain. Microb Drug Resist. 2015;21:215–7.
pubmed: 25386800
doi: 10.1089/mdr.2014.0155