Clinical Outcomes and Bacterial Characteristics of Carbapenem-Resistant Acinetobacter baumannii Among Patients from Different Global Regions

Authors

• Minggui Wang, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
• Lizhao Ge, The Biostatistics Center, George Washington University, Rockville, MD, USA.
• Liang Chen, Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA.
• Lauren Komarow, The Biostatistics Center, George Washington University, Rockville, MD, USA.
• Blake Hanson, Center for Infectious Diseases and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, TX, USA.
• Jinnethe Reyes, Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia.
• Eric Cober, Department of Infectious Diseases, Cleveland Clinic, OH, USA.
• Thamer Alenazi, College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
• Zhiyong Zong, Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
• Qing Xie, Department of Infectious Disease, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
• Zhengyin Liu, Infectious Disease Section, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China.
• Lanjuan Li, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China.
• Yunsong Yu, Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
• Hainv Gao, Department of Infectious Diseases, Shulan Hangzhou Hospital, Hangzhou, China.
• Souha S. Kanj, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
• Jairo Figueroa, Department of Infectious Diseases, Hospital Universitario Erasmo Meoz ESE, Cúcuta, Colombia.
• Erica Herc, Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA.
• Ezequiel Cordova, Infectious Diseases Unit, Hospital Cosme Argerich de Buenos Aires, Buenos Aires, Argentina.
• Gregory Weston, Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
• Paul Ananth Tambyah, Infectious Diseases Translational Research Programme, National University of Singapore, Singapore.
• Julia Garcia-Diaz, Division of Infectious Diseases, Ochsner Medical Center, New Orleans, LA, USA.
• Keith S. Kaye, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA.
• Sorabh Dhar, Division of Infectious Disease, School of Medicine, Wayne State University, Detroit, MI, USA.
• Jose M. Munita, Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
• Robert A. Salata, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
• Samuel Vilchez, Center for Infectious Disease Research, Department of Microbiology and Parasitology, School of Medicine, National Autonomous University of Nicaragua, Leon, Nicaragua.
• Martin E. Stryjewski, Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina.
• Maria Virginia Villegas Botero, Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia.
• Alina Iovleva, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
• Scott Evans, Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China.
• Keri Baum, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
• Carol Hill, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.

Document Type

Journal Article

Publication Date

9-20-2023

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

DOI

10.1093/cid/ciad556

Keywords

carbapenem-resistant Acinetobacter baumannii; clinical impact; international epidemiology

Abstract

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAb) is one of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb. METHODS: In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis. RESULTS: Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs. 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases. CONCLUSIONS: CRAb infection types and clinical outcomes differed significantly across regions. While CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. CLINICALTRIALS.GOV: #NCT03646227.

APA Citation

Wang, Minggui; Ge, Lizhao; Chen, Liang; Komarow, Lauren; Hanson, Blake; Reyes, Jinnethe; Cober, Eric; Alenazi, Thamer; Zong, Zhiyong; Xie, Qing; Liu, Zhengyin; Li, Lanjuan; Yu, Yunsong; Gao, Hainv; Kanj, Souha S.; Figueroa, Jairo; Herc, Erica; Cordova, Ezequiel; Weston, Gregory; Ananth Tambyah, Paul; Garcia-Diaz, Julia; Kaye, Keith S.; Dhar, Sorabh; Munita, Jose M.; Salata, Robert A.; Vilchez, Samuel; Stryjewski, Martin E.; Villegas Botero, Maria Virginia; Iovleva, Alina; Evans, Scott; Baum, Keri; and Hill, Carol, "Clinical Outcomes and Bacterial Characteristics of Carbapenem-Resistant Acinetobacter baumannii Among Patients from Different Global Regions" (2023). GW Authored Works. Paper 3370.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3370

Department

Biostatistics and Bioinformatics