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

Fecha de publicación: 20/09/2023 Fecha Ahead of Print: 01/09/2023

Autores organización

Jinnethe Cristina Reyes Manrique

Autor
Maria Virginia Villegas Botero

Autor

Autores

Wang, MG
Ge, LZ
Chen, L
Komarow, L
Hanson, B
Cober, E
Alenazi, T
Zong, ZY
Xie, Q
Liu, ZY
Li, LJ
Yu, YS
Gao, H
Kanj, SS
Figueroa, J
Herc, E
Cordova, E
Weston, G
Tambyah, PA
Garcia-Diaz, J
Kaye, KS
Dhar, S
Munita, JM
Salata, RA
Vilchez, S
Stryjewski, ME
Iovleva, A
Evans, SR
Baum, K
Hill, C
Kreiswirth, BN
Patel, R
Paterson, DL
Arias, CA
Bonomo, RA
Chambers, HF
Fowler, VG
Satlin, MJ
van Duin, D
Doi, YH
Multi-Drug Resistant Organism

Grupos de investigación

Resumen

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.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. In this international, prospective observational cohort of 842 hospitalized patients with carbapenem-resistant Acinetobacter baumannii, infection types and clinical outcomes differed significantly across regions. Although clonal group 2 (CG2) strains were predominant, non-CG2 strains were associated with higher mortality.