Clinical Outcomes and Bacterial Characteristics of Carbapenem-Resistant Acinetobacter baumannii Among Patients from Different Global Regions
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
carbapenem-resistant Acinetobacter baumannii; clinical impact; international epidemiology
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.
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.
Biostatistics and Bioinformatics