Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit

Shi, Jingyi; Sun, Ting; Cui, Yun; Wang, Chunxia; Wang, Fei; Zhong, Yiping; Miao, Huijie; Shan, Yijun; Zhang, Yucai

doi:10.1186/s12879-020-05321-y

Cited by 44 publications

(36 citation statements)

References 33 publications

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“…We investigated the in vitro activity of colistin, indicating that all A. baumannii isolates were susceptible to colistin according to the MIC50 and MIC90 values of < 2 µg/ml. Significantly, both MDR and XDR A. baumannii were susceptible to colistin which are in concordance with previous studies [ 13 , 31 ].…”

Section: Discussionsupporting

confidence: 93%

“…The incidence of MDR A. baumannii in pediatric patients is increasing worldwide as far as it has led to therapeutic challenges and has become an ongoing serious public health concern [ 13 ]. In this study, we described a high antibiotic resistance rate, rising MDR and XDR strains, and widespread prevalence of β-lactamase-encoding genes in A. baumannii isolated from pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of β-lactamase-encoding genes and molecular typing of Acinetobacter baumannii isolates carrying carbapenemase OXA-24 in children

Yousefi

Sadredinamin

Dehbanipour

et al. 2021

Ann Clin Microbiol Antimicrob

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Background β-Lactam antibiotics have been broadly used for the treatment of Acinetobacter baumannii infections, resulting in development of β-lactam inactivating β-lactamases. Here, we described antibiotic resistance rate, prevalence of β-lactamase-encoding genes, and clonal relationships of A. baumannii strains isolated from children referred to Children’s Medical Center in Tehran, Iran, during 2019–2020. Methods A total of 60 non-replicate A. baumannii isolates were recovered from clinical specimens of pediatric patients. Antibiotic susceptibility testing was done by the disc diffusion method. Colistin susceptibility of isolates was performed by the broth microdilution method. β-lactamase-encoding genes were characterized by PCR. The presence of ISAba1 element upstream of the several oxacillinase genes was also checked. Genetic relatedness of isolates was determined by using random amplification of polymorphic DNA (RAPD) typing. Results The antimicrobial susceptibility tests showed that 83.3% of A. baumannii isolates were MDR, and 40% XDR. Both MDR and XDR A. baumannii isolates were susceptible to colistin. The frequency of blaOXA-51-like, blaOXA-23-like, blaTEM, blaOXA-24-like, blaPER, blaSHV, blaCTX-M, blaOXA-58-like, and blaIMP was 100, 93.33, 60, 36.67, 28.33, 8.33, 5, 3.33, and 1.67%, respectively. Coexistence of ISAba1/blaOXA-23-like and ISAba1/blaOXA-51-like was observed in 65% and 85% of isolates, respectively. RAPD analysis revealed 4 common types and 2 single types of A. baumannii isolates. Conclusions The multiple clones harboring blaOXA-23-like, ISAba1-blaOXA-51-like, and ISAba1-blaOXA-23-like were responsible for the spread of A. baumannii isolates in our clinical wards. Dissemination of the well-established clones is worrisome and would become therapeutic challenges due to the possible transferring genetic elements associated with resistance.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Prevalence of β-lactamase-encoding genes and molecular typing of Acinetobacter baumannii isolates carrying carbapenemase OXA-24 in children

Yousefi

Sadredinamin

Dehbanipour

et al. 2021

Ann Clin Microbiol Antimicrob

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“…A. baumannii , is a conditional pathogen ( 106 ), which often leads to pneumonia ( 107 ), meningitis ( 108 ) and bacteremia ( 109 ). It causes hospital infection frequently ( 110 ) and is often resistant to a variety of antimicrobial agents ( 111 ), bringing great difficulties to the clinical treatment. Fortunately, melatonin effectively inhibits the growth of A. baumannii ( 54 ), suggesting it may be suitable as adjunctive therapy in hospital infection.…”

Section: Bacteriostatic Actions Of Melatonin In Vitro and Their Underlying Mechanismsmentioning

confidence: 99%

Bacteriostatic Potential of Melatonin: Therapeutic Standing and Mechanistic Insights

Zhang

et al. 2021

Front. Immunol.

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Diseases caused by pathogenic bacteria in animals (e.g., bacterial pneumonia, meningitis and sepsis) and plants (e.g., bacterial wilt, angular spot and canker) lead to high prevalence and mortality, and decomposition of plant leaves, respectively. Melatonin, an endogenous molecule, is highly pleiotropic, and accumulating evidence supports the notion that melatonin’s actions in bacterial infection deserve particular attention. Here, we summarize the antibacterial effects of melatonin in vitro, in animals as well as plants, and discuss the potential mechanisms. Melatonin exerts antibacterial activities not only on classic gram-negative and -positive bacteria, but also on members of other bacterial groups, such as Mycobacterium tuberculosis. Protective actions against bacterial infections can occur at different levels. Direct actions of melatonin may occur only at very high concentrations, which is at the borderline of practical applicability. However, various indirect functions comprise activation of hosts’ defense mechanisms or, in sepsis, attenuation of bacterially induced inflammation. In plants, its antibacterial functions involve the mitogen-activated protein kinase (MAPK) pathway; in animals, protection by melatonin against bacterially induced damage is associated with inhibition or activation of various signaling pathways, including key regulators such as NF-κB, STAT-1, Nrf2, NLRP3 inflammasome, MAPK and TLR-2/4. Moreover, melatonin can reduce formation of reactive oxygen and nitrogen species (ROS, RNS), promote detoxification and protect mitochondrial damage. Altogether, we propose that melatonin could be an effective approach against various pathogenic bacterial infections.

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“…Among critically ill patients, the estimated increase in the in-hospital mortality rate due to A. baumannii infection ranges between 7.8 and 23%, and the attributable ICU mortality ranges from 10 to 43% (29). High mortality rates have been reported in patients infected with drug-resistant A. baumannii (30,31). However, only a few studies have elucidated the association between mortality and colonization of drug-resistant strains.…”

Section: Discussionmentioning

confidence: 99%

Colonization With Extensively Drug-Resistant Acinetobacter baumannii and Prognosis in Critically Ill Patients: An Observational Cohort Study

Zheng

Pang

et al. 2021

Front. Med.

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Background:Acinetobacter baumannii is one of the most frequently isolated opportunistic pathogens in intensive care units (ICUs). Extensively drug-resistant A. baumannii (XDR-AB) strains lack susceptibility to almost all antibiotics and pose a heavy burden on healthcare institutions. In this study, we evaluated the impact of XDR-AB colonization on both the short-term and long-term survival of critically ill patients.Methods: We prospectively enrolled patients from two adult ICUs in Qilu Hospital of Shandong University from March 2018 through December 2018. Using nasopharyngeal and perirectal swabs, we evaluated the presence of XDR-AB colonization. Participants were followed up for 6 months. The primary endpoints were 28-day and 6-month mortality after ICU admission. The overall survival rate was estimated by the Kaplan-Meier method. We identified risk factors associated with 28-day and 6-month mortality using the logistic regression model and a time-dependent Cox regression model, respectively.Results: Out of 431 patients, 77 were colonized with XDR-AB. Based on the Kaplan-Meier curve results, the overall survival before 28 days did not differ by colonization status; however, a significantly lower overall survival rate was obtained at 6 months in colonized patients. Univariate and multivariate analysis results confirmed that XDR-AB colonization was not associated with 28-day mortality, but was an independent risk factor of lower overall survival at 6 months (HR = 1.749, 95% CI = 1.174–2.608).Conclusions: XDR-AB colonization has no effect on short-term overall survival, but is associated with lower long-term overall survival in critically ill patients.

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Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit

Cited by 44 publications

References 33 publications

Prevalence of β-lactamase-encoding genes and molecular typing of Acinetobacter baumannii isolates carrying carbapenemase OXA-24 in children

Prevalence of β-lactamase-encoding genes and molecular typing of Acinetobacter baumannii isolates carrying carbapenemase OXA-24 in children

Bacteriostatic Potential of Melatonin: Therapeutic Standing and Mechanistic Insights

Colonization With Extensively Drug-Resistant Acinetobacter baumannii and Prognosis in Critically Ill Patients: An Observational Cohort Study

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