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


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



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.


Biostatistics and Bioinformatics