Risk factors and outcomes in patients with carbapenem-resistant Acinetobacter infection

Vitkauskienė, Astra; Dambrauskienė, Asta; Černiauskienė, Kristina; Rimdeika, Rytis; Sakalauskas, Raimundas

doi:10.3109/00365548.2012.724178

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…Because the isolates were not available for further analysis, the mechanisms of carbapenem resistance in A. baumannii and P. aeruginosa isolates could not be evaluated. Prolonged hospitalization (25)(26)(27), previous carbapenem use (1,(25)(26)(27)(28)(29)(30), ICU care (25,27,29), and the presence of medical devices (26)(27)(28) are considered risk factors for CR A. baumannii and CR P. aeruginosa colonization. The risk factors for CRGNB were similar to the risk fac- tors for CR A. baumannii and CR P. aeruginosa colonization.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Lee

Kang

et al. 2016

Antimicrob Agents Chemother

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bWith the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB were Stenotrophomonas maltophilia (n ‫؍‬ 33), Acinetobacter baumannii (n ‫؍‬ 32), Pseudomonas aeruginosa (n ‫؍‬ 21), and others (n ‫؍‬ 15). Approximately 90% of S. maltophilia isolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest that S. maltophilia, A. baumannii, and P. aeruginosa are the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.C arbapenems, such as meropenem, imipenem, and doripenem, are the currently preferred agents for treating serious bacterial infections caused by multidrug-resistant (MDR) Gram-negative pathogens, such as members of the Enterobacteriaceae producing extended-spectrum ␤-lactamases or AmpC ␤-lactamase, Pseudomonas aeruginosa, and Acinetobacter baumannii (1). With the increasing use of carbapenems, however, carbapenem-resistant (CR) Gram-negative bacteria have become a major concern in health care-associated infections (2). In the United States, more than 23,000 infections caused by MDR A. baumannii, MDR P. aeruginosa, or CR Enterobacteriaceae are reported annually (3). In the Republic of Korea, the incidence of imipenem-resistant A. baumannii infections increased from 43.6% in 2006 to 82.5% in 2010 in intensive care unit (ICU) patients (4).The term "breakthrough bacteremia" is defined as an episode of continuous or new-onset bacteremia in a patient receiving appropriate antibiotics for the microorganism recovered from blood cultures (5-11). In addition to the use of unsuitable antibioticsdue to either resistance of the microorganism (5, ...

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Lee

Kang

et al. 2016

Antimicrob Agents Chemother

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“…Risk of the various A. baumannii resistance phenotypes is either a matter of previous antimicrobial exposure (likely the selection of a resistant phenotype within a patient) or patient exposure to an environment where an outbreak-type pathogen is lurking [ 14 , 115 , 116 ]. Clinicians are encouraged to review their local antibiogram to understand the current A. baumannii phenotypes most likely to be present in their patients.…”

Section: Host Factorsmentioning

confidence: 99%

Contemporary Perspective on the Treatment of Acinetobacter baumannii Infections: Insights from the Society of Infectious Diseases Pharmacists

et al. 2021

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The purpose of this narrative review is to bring together the most recent epidemiologic, preclinical, and clinical findings to offer our perspective on best practices for managing patients with A. baumannii infections with an emphasis on carbapenem-resistant A. baumannii (CRAB). To date, the preferred treatment for CRAB infections has not been defined. Traditional agents with retained in vitro activity (aminoglycosides, polymyxins, and tetracyclines) are limited by suboptimal pharmacokinetic characteristics, emergence of resistance, and/or toxicity. Recently developed and US Food and Drug Administration (FDA)-approved β-lactam/β-lactamase inhibitor agents do not provide enhanced activity against CRAB. On balance, cefiderocol and eravacycline demonstrate potent in vitro activity and are well tolerated, but clinical data for patients with CRAB infections do not yet support widespread use. Given that CRAB has the capacity to infect vulnerable patients and preferred regimens have not been identified, we advocate for combination therapy. Our preferred regimen for critically ill patients infected, or considered to be at high risk for CRAB, includes meropenem, polymyxin B, and ampicillin/sulbactam. Importantly, site of infection, severity of illness, and local epidemiology are essential factors to be considered in selecting combination therapies. Molecular mechanisms of resistance may unveil preferred combinations at individual centers; however, such data are often unavailable to treating clinicians and have not been linked to improved clinical outcomes. Combination strategies may also pose an increased risk for antibiotic toxicity and Clostridioides difficile infection, and should therefore be balanced by understanding patient goals of care and underlying health conditions. Promising therapies that are in clinical development and/or under investigation include durlobactam–sulbactam, cefiderocol combination regimens, and bacteriophage therapy, which may over time eliminate the need for the continued use of polymyxins. Future goals for CRAB management include pathogen-focused treatment paradigms that are based on molecular mechanisms of resistance, local susceptibility rates, and the availability of well-tolerated, effective treatment options.

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“…23 It is important to note that according to the data from some clinical studies, resistance to carbapenems by itself has no impact on mortality rates in patients with A. baumannii infections. [24][25][26] And finally, a systematic review of matched casecontrol and cohort studies examining the mortality that is attributable to infection or colonization with A. baumannii revealed that statistically significant higher mortality was associated with A. baumannii infection or colonization. 16 In the hospital and in the intensive care units the attributable mortalities of pa-tients with A. baumannii infection ranged from 7.8% to 23% and from 10% to 43% respectively.…”

Section: Resultsmentioning

confidence: 99%

Impact of appropriate antimicrobial therapy on survival in patients with Acinetobacter baumannii-associated infections

Gorbich¹,

Karpov²,

Kretchikova³

2015

Journal of Microbiology and Infectious Diseases

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Objective: To assess the impact of inappropriate antimicrobial treatment on the 30-day mortality in patients with Acinetobacter baumannii associated infections.Methods: 87 patients with nosocomial infections caused by A. baumannii were included in the study. Among them 39 patients had favorable outcome, while 48 patients died within 30 days after pathogen isolation. In order to assess the impact of antimicrobial therapy on outcomes, the cases with appropriate antimicrobial treatment from both studied groups were compared with the cases in which patient's received inappropriate therapy. The Chi-square or Z-test was used to assess differences in categorical variables. Continuous variables were compared using the Mann-Whitney test.Results: Among patients with favorable outcomes four people received appropriate empirical antimicrobial treatment, while in the other group only three patients. The odds ratio was 1.7 (95% CI 0.4-8.2; p=0.77). Appropriate antimicrobial agents were administered as a part of causal treatment to 27 patients who survived and to 11 patients who died within 30 days after pathogen isolation. The odds ratio was 6.7 (95% CI 2.6-17.3; p<0.001). Conclusion

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Risk factors and outcomes in patients with carbapenem-resistant Acinetobacter infection

Cited by 14 publications

References 22 publications

Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Contemporary Perspective on the Treatment of Acinetobacter baumannii Infections: Insights from the Society of Infectious Diseases Pharmacists

Impact of appropriate antimicrobial therapy on survival in patients with Acinetobacter baumannii-associated infections

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