Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients From Different Global Regions

Medientyp: E-Artikel

Titel: Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients From Different Global Regions

Beteiligte: 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; [...]

Erschienen: Oxford University Press (OUP), 2024

Sprache: Englisch

DOI: 10.1093/cid/ciad556

ISSN: 1058-4838; 1537-6591

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Beschreibung: Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 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. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinical Trials Registration. NCT03646227.

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