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

Abstract

Introduction. Increasing evidence demonstrates unfavourable outcomes in bloodstream infections (BSI) due to the carbapenemresistant Acinetobacter baumannii complex (CRAB).Aim. To investigate the differences in risk factors, clinical characteristics and outcomes in patients with A. baumannii complex BSI stratified by carbapenem resistance, a prospective multi-center study was conducted.Methodology. Information was collected in a predefined form. A total of 317 cases was included for comparison between CRAB BSI vs. carbapenem-susceptible A. baumannii complex (CSAB) BSI. Among these cases, 229 cases were defined as CRAB BSI and 88 cases as CSAB BSI.Results. Univariable analysis showed that male gender, underlying neurologic disease, prior carbapenems exposure, intensive care unit (ICU) stay, presence of central venous catheter, endotracheal intubation, tracheotomy, Foley catheter, nasogastric intubation, lower respiratory tract infections and catheter-related infections were more prevalent in CRAB BSI. Only male gender, prior carbapenems exposure and presence of endotracheal intubation persisted as independent risk factors for acquiring CRAB BSI. Patients with CRAB BSI displayed unfavourable outcomes characterized by failure of pathogen clearance, continuous fever, disease aggravation and higher incidence of 30-day all-cause mortality. Multivariate analysis demonstrated carbapenem resistance as an independent risk factor for 30-day all-cause mortality.Conclusion. Our findings reveal the epidemiological differences between CRAB BSI and CSAB BSI in a Chinese cohort. Our data suggest that carbapenem resistance has a significant impact on mortality for patients with A. baumannii complex BSI, further strengthening the importance of active prevention and control strategies for the spread of CRAB in Chinese hospitals.

An outbreak of carbapenem-resistant Acinetobacter baumannii in a COVID-19 dedicated hospital

“…Risk factors for the acquisition of CRAB include endotracheal intubation and carbapenem use [ 8 , 9 ]. All patients in our outbreak were mechanically ventilated, but none were exposed to carbapenems before acquisition of CRAB.…”

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

“…This study was an investigative and predictive analysis based on BSI patients' clinical data from the CARES study (Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections), which is a nationwide, longitudinal, prospective study encompassing 16 tertiary-care teaching hospitals in 10 provinces in China between 2007 and 2016 (15)(16)(17). Each hospital has at least 1,200 beds and one infectious disease department and infection control committee with specialist doctors, nurses, and microbiological laboratory personnel.…”

Surveillance of Multidrug-Resistant Bacterial Infections in Non-Adult Patients — Zhejiang Province, China, 2014–2019

“…Investigating the pattern of pathogens in the ICU environment, especially for MDR organisms, will help develop specific prevention and control strategies. A recent study in a tertiary teaching hospital in western China reported that Acinetobacter baumannii was the leading cause of infection in almost every ICU (7). In this study, ESBL-E was the most prevalent pathogen in ICU non-adult patients in Zhejiang Province (43.4% to 53.8%).…”