Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study

Russo, Alessandro; Bassetti, Matteo; Ceccarelli, Giancarlo; Carannante, Novella; Losito, Angela Raffaella; Bartoletti, Michele; Corcione, Silvia; Granata, Guido; Santoro, Antonella; Giacobbe, Daniele Roberto; Vena, Antonio; Amadori, Francesco; Segala, Francesco Vladimiro; Giannella, Maddalena; Caprio, Giovanni Di; Menichetti, Francesco; Bono, Valerio Del; Mussini, Cristina; Petrosillo, Nicola; Rosa, Francesco Giuseppe De; Viale, Pierluigi; Tumbarello, Mario; Tascini, Carlo; Viscoli, Claudio; Venditti, Mario; Isgri-Sita,

doi:10.1016/j.jinf.2019.05.017

Cited by 86 publications

(80 citation statements)

References 38 publications

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“…Of importance, multivariate analysis after a propensity score for receiving therapy with fosfomycin confirmed the role of septic shock and bacteremia to determinate 30-day mortality; conversely, a fosfomycincontaining regimen was independently associated with survival at 30 days. Recent studies confirmed data about mortality [2,5], with rates [ 90% in patients with septic shock [9,10]. MDR-AB bloodstream infections remain a peculiar ICU-acquired infection, although recent data reported high rates of infection even in medical and surgical wards.…”

Section: Discussionmentioning

confidence: 55%

“…In recent years, severe pneumonia due to multidrug-resistant (MDR) gram-negative bacteria such as Acinetobacter baumannii (AB) has been increasingly observed among hospitalized patients admitted to the intensive care unit (ICU), surgical and medical wards [1,2]. MDR-AB has been listed as one of the top priority pathogens by the World Health Organization [3,4]; specifically, in Italy an increased incidence of MDR-AB was observed in the last years [5].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study

et al. 2020

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Introduction: Severe pneumonia caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) remains a difficult-to-treat infection. Considering the poor lung penetration of most antibiotics, the choice of the better antibiotic regimen is debated. Methods: We performed a prospective, observational, multicenter study conducted from January 2017 to June 2020. All consecutive hospitalized patients with severe pneumonia due to MDR-AB were included in the study. The primary endpoint of the study was to evaluate risk factors associated with survival or death at 30 days from pneumonia onset. A propensity score for receiving therapy with fosfomycin was added to the model. Results: During the study period, 180 cases of hospital-acquired pneumonia, including ventilator-associated pneumonia, caused by MDR-AB strains were observed. Cox regression analysis of factors associated with 30-day mortality, after propensity score, showed that septic shock, and secondary bacteremia were associated with death, while a fosfomycin-containing regimen was associated with 30-day survival. Antibiotic combinations with fosfomycin in definitive therapy for 44 patients were: fosfomycin ? colistin in 11 (25%) patients followed by fosfomycin ? carbapenem ? tigecycline in 8 (18.2%), fosfomycin ? colistin ? tigecycline in 7 (15.9%), fosfomycin ? rifampin in 7 (15.9%), fosfomycin ? tigecycline in 6 (13.6%), fosfomycin ? carbapenem in 3 (6.8%), and fosfomycin ? aminoglycoside in 2 (4.5%).

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study

et al. 2020

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“…This study was conducted at the First A liated Hospital of Wenzhou Medical University, a 4100-bed teaching hospital (Wenzhou, China), over a 6-year period (1 January 2013 to 31 December 2018). Inclusion criteria of A. baumannii-induced bloodstream infection include [13]: (1) age ≥ 18 years; (2) blood culture positive for MDR-AB; (3) clinical signs consistent with infection; (4) the infection occurred ≥ 48 h after hospital admission. Only the rst episode was included if the patient had multiple episodes of A. baumannii-induced BSI.…”

Section: Study Location and Patientmentioning

confidence: 99%

Bloodstream infections caused by ST2 Acinetobacter baumannii over 6 years in China: risk factors, antibiotic regimens and virulence

Zeng

et al. 2020

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Background Acinetobacter baumannii (Ab) is an important pathogen of medical-related infections, A.baumannii sequence type 2 (ST2) has spread all over the world. To the best of our knowledge, this is the first study to analyze the clinical and microbiological characteristics of patients with bloodstream infection (BSI) due to ST2 A.baumannii. Methods A retrospective study was conducted in a large tertiary hospital in China. From January 2013 to December 2018, the clinical and microbiological data of all consecutive hospitalized patients with bacteremia due to multidrug-resistant A.baumannii (MDR-AB) were included and analyzed comprehensively. Results A total of 108 episodes of BSI due to MDR-AB cases were enrolled during the study period. Overall, 30-day mortality was 69.4% (75/108). The use of mechanical ventilation, intensive care unit (ICU) stay and thrombocytopenia may cause higher mortality (P = 0.048, P < 0.001, and P < 0.001, respectively). Change antimicrobial within 48 h after isolating from blood, use of antibacterial combination and more inpatient days were significantly associated with survival (P < 0.001, P = 0.037, and P = 0.007, respectively). All MDR isolates belong to ST2, and have strong biofilm formation ability and high pathogenicity. Conclusions BSI caused by ST2 A.baumannii represents a difficult challenge for physicians, considering the high mortality associated with this infection. The combination of cefoperazone/sulbactam and tigecycline may be a meaningful treatment option.

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“…Overall, previous studies found that the prognosis of A. baumannii BSI in ICU patients is different depending on the underlying disease, illness severity, drug resistance, therapies used, post-infection appearance and infection source. The following characteristics often lead to poor prognosis: improper initial antibiotic treatment [9,38], comorbidities (tumours [38,44,45], liver cirrhosis [46], chronic obstructive pulmonary disease and chronic renal failure [37]), high drug resistance, neutropenia [38], previous high-dose hormone therapy [47], previous surgery [9], infection originated from the respiratory tract [35,46], high SAPS score [8], Pitt score [35], APACHE II score [37,38,46]. However, the development of septic shock [47] and the severity of the disease are the factors most closely related to prognosis, and our study also found these two key points.…”

Section: Prognostic Analysis Of Mdr-a Baumannii Bsismentioning

confidence: 99%

“…However, the development of septic shock [47] and the severity of the disease are the factors most closely related to prognosis, and our study also found these two key points. A study [9] focused on ICU patients found that patients developing septic shock after MDR-A. baumannii BSI have a 23.8% higher mortality rate than patients without septic shock (82.5% vs 58.7%).…”

Section: Prognostic Analysis Of Mdr-a Baumannii Bsismentioning

confidence: 99%

Comparison of clinical characteristics and outcomes of bloodstream infections due to multidrug-resistant Acinetobacter baumannii and other Gram-negative bacteria in ICU patients

Ying¹,

Xie²,

Mao³

et al. 2020

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Background: Multidrug-resistant (MDR) bloodstream infection (BSI) by Gram-negative bacteria (GNB) is an important cause of mortality in the intensive care unit (ICU). The purpose of this study was to compare the clinical characteristics of some GNB BSIs and to analyze their drug resistance, with an emphasis on the analysis of prognostic risk factors related to MDR-Acinetobacter baumannii (A. baumannii) BSI.Methods: A retrospective study was conducted in the ICU of lianyungang hospital in China. Patients with BSIs due to MDR-A. baumannii, MDR-Klebsiella pneumoniae (K. pneumoniae), MDR-Pseudomonas aeruginosa (P. aeruginosa) and MDR-Escherichia coli (E. coli) were included.Results: The overall drug resistance rate to imipenem of A. baumannii and K. pneumoniae was significantly higher than that of P. aeruginosa and E. coli (95.8% and 75.5% vs 44.6% and 9.2% respectively). The mortality rates were 71.9%, 63.3%, 41.5% and 38.1%, respectively. The multivariate analysis of MDR-A. baumannii BSI, APACHE II score, hormone use, development of septic shock were associated with the 30-day mortality, while high albumin level with survival.Conclusion: The treatment of MDR-A. baumannii and MDR-K. pneumoniae infection resulted difficult due to their high drug resistance rate. However, the understanding of the clinical characteristics of different BSIs might be helpful to predict, to some extent, the pathogenic bacteria involved so as to proceed with an early sensitive antibiotic treatment. The high mortality rate due to BSI MDR-A. baumannii might be correlated with APACHE II score, nutritional status, and hormone therapy, while septic shock was a warning sign of poor prognosis.

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Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study

Cited by 86 publications

References 38 publications

Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study

Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study

Bloodstream infections caused by ST2 Acinetobacter baumannii over 6 years in China: risk factors, antibiotic regimens and virulence

Comparison of clinical characteristics and outcomes of bloodstream infections due to multidrug-resistant Acinetobacter baumannii and other Gram-negative bacteria in ICU patients

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Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study

Cited by 86 publications

References 38 publications

Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study

Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study

Bloodstream infections caused by ST2 Acinetobacter baumannii&nbsp;over 6 years in China: risk factors, antibiotic regimens and virulence

Comparison of clinical characteristics and outcomes of bloodstream infections due to multidrug-resistant Acinetobacter baumannii and other Gram-negative bacteria in ICU patients

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Bloodstream infections caused by ST2 Acinetobacter baumannii over 6 years in China: risk factors, antibiotic regimens and virulence