Prognostic risk factors associated with bloodstream infections caused by <i>Acinetobacter baumannii</i>_West China Medical Journal

Authors：

LIANG Liang ¹ ,  LIU Xiaochun ¹ , CHEN Xingchun ¹ , ZHAO Li ¹ , PANG Guangbao ² , HE Yi ³ , TANG Juan ³ , ZHOU Xiangyang ³

1. Department of Clinical Laboratory, Guangxi Zhuang Autonomous Region People’s Hospital, Nanning, Guangxi 530021, P. R. China;
2. Intensive Care Unit, Guangxi Zhuang Autonomous Region People’s Hospital, Nanning, Guangxi 530021, P. R. China;
3. Guangxi Center for Clinical Laboratory, Nanning, Guangxi 530021, P. R. China;

Corresponding author：

LIU Xiaochun, Email: tonyliu75@126.com

Keywords：

Acinetobacter baumannii; Bloodstream infection; Multidrug resistance; Risk factor; Prognosis

DOI：

10.7507/1002-0179.201911221

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Objective To explore the prognostic risk factors of bloodstream infections caused by Acinetobacter baumannii in the hospital, to provide a basis for clinical diagnosis and treatment.Methods A retrospective analysis was performed on the medical records of patients diagnosed with Acinetobacter baumannii bloodstream infection in Guangxi Zhuang Autonomous Region People’s Hospital between January 2013 and December 2018. The patients were divided into survival group and non-survival group according to the outcome within 30 days after blood culture was collected. Univariate and multivariate logistic analyses were used to identify the risk factors of Acinetobacter baumannii bloodstream infections.Results A total of 123 patients were included, including 48 in the survival group and 75 in the non-survival group. Third generation cephalosporins [odds ratio (OR)=2.492, 95% confidence interval (CI) (2.125, 2.924), P<0.001], carbapenems [OR=1.721, 95%CI (1.505, 1.969), P<0.001], multidrug resistant-Acinetobacter baumannii infection [OR=1.240, 95%CI (1.063, 1.446), P=0.006], post-operation [OR=0.515, 95%CI (0.449, 0.590), P<0.001], mechanical ventilation [OR=1.182, 95%CI (1.005, 1.388), P=0.043], indwelling central venous catheter [OR=0.116, 95%CI (0.080, 0.169), P<0.001], mixed infection or septic shock [OR=3.935, 95%CI (2.740, 5.650), P<0.001], APACHE Ⅱ score (≥15) [OR=5.939, 95%CI (5.029, 7.013), P<0.001], chronic kidney disease [OR=1.440, 95%CI (1.247, 1.662), P<0.001], immune system disease [OR=28.620, 95%CI (17.087, 47.937), P<0.001], use of corticosteroids [OR=0.520, 95%CI (0.427, 0.635), P<0.001], and combined antifungal agents [OR=0.814, 95%CI (0.668, 0.992), P=0.041] were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii.Conclusions The third generation cephalosporins, carbapenem, MDR-Acinetobacter baumannii infection, post-operation, mechanical ventilation, indwelling central venous catheter, mixed infection or septic shock, APACHE Ⅱ score (≥15), chronic kidney disease, immune system disease, use of corticosteroids, and combined antifungal agents were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii. In the clinical work, it is needed to carry out timely detection of microbial etiology, timely report, and reasonable treatment.

Citation： LIANG Liang, LIU Xiaochun, CHEN Xingchun, ZHAO Li, PANG Guangbao, HE Yi, TANG Juan, ZHOU Xiangyang. Prognostic risk factors associated with bloodstream infections caused by Acinetobacter baumannii. West China Medical Journal, 2021, 36(1): 76-81. doi: 10.7507/1002-0179.201911221 Copy

1.	Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs: no ESKAPE! An update from the infectious diseases society of America. Clin Infect Dis, 2009, 48(1): 1-12.
2.	王成军, 许勇, 王林海, 等. 鲍氏不动杆菌感染的临床分布特征及耐药性分析. 中华医院感染学杂志, 2014, 24(17): 4179-4181.
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6.	中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
7.	Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
8.	王盛标, 李涛, 李云峰, 等. 4 种评分系统对脓毒症患者预后的评估价值: 附 311 例回顾性分析. 中华危重病急救医学, 2017, 29(2): 133-138.
9.	中华人民共和国国家卫生健康委员会. 国家卫生计生委办公厅关于印发麻醉等6个专业质控指标(2015年版)的通知. (2015-04-10)[2019-11-20]. http://www.nhc.gov.cn/wjw/pyzl/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
10.	Thom KA, Johnson JK, Lee MS, et al. Environmental contamination because of multidrug-resistant Acinetobacter baumannii surrounding colonized or infected patients. Am J Infect Control, 2011, 39(9): 711-715.
11.	Ryu SY, Baek WK, Kim HA. Association of biofilm production with colonization among clinical isolates of Acinetobacter baumannii. Korean J Intern Med, 2017, 32(2): 345-351.
12.	Ketter PM, Yu JJ, Guentzel MN, et al. Acinetobacter baumannii gastrointestinal colonization is facilitated by secretory IgA which is reductively dissociated by bacterial thioredoxin A. MBio, 2018, 9(4): e01298-18.
13.	张银维, 周华, 蔡洪流, 等. 鲍曼不动杆菌血流感染临床特征和死亡危险因素分析. 中华内科杂志, 2016, 55(2): 121-126.
14.	Pu L, Jian Z, Pan F, et al. Comparative genomic analysis and multi-drug resistance differences of Acinetobacter baumannii in Chongqing, China. Infect Drug Resist, 2019, 12: 2827-2838.
15.	Zhang X, Gu B, Mei Y, et al. Increasing resistance rate to carbapenem among blood culture isolates of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa in a university-affiliated hospital in China, 2004-2011. J Antibiot (Tokyo), 2015, 68(2): 115-120.
16.	韩静静, 邓艳萍, 高鑫, 等. ICU 中革兰阴性菌血流感染的危险因素分析. 重庆医学, 2016, 45(12): 1638-1640, 1644.
17.	Guo N, Xue W, Tang D, et al. Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China. Am J Infect Control, 2016, 44(4): e37-e39.
18.	张青, 王小亭, 张宏民, 等. 重症临床急性生理学及慢性健康状况系统评分与人工评分的比较. 中华医学杂志, 2015, 95(39): 3173-3175.

1. Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs: no ESKAPE! An update from the infectious diseases society of America. Clin Infect Dis, 2009, 48(1): 1-12.
2. 王成军, 许勇, 王林海, 等. 鲍氏不动杆菌感染的临床分布特征及耐药性分析. 中华医院感染学杂志, 2014, 24(17): 4179-4181.
3. 胡付品, 郭燕, 朱德妹, 等. 2016 年中国 CHINET 细菌耐药性监测. 中国感染与化疗杂志, 2017, 17(5): 481-491.
4. Kasper DL, Fauci AS. 哈里森感染病学. 3 版. 胡必杰, 潘珏, 高晓东, 译. 上海: 上海科学技术出版社, 2019: 469.
5. Liu CP, Shih SC, Wang NY, et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2016, 49(6): 934-940.
6. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
7. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
8. 王盛标, 李涛, 李云峰, 等. 4 种评分系统对脓毒症患者预后的评估价值: 附 311 例回顾性分析. 中华危重病急救医学, 2017, 29(2): 133-138.
9. 中华人民共和国国家卫生健康委员会. 国家卫生计生委办公厅关于印发麻醉等6个专业质控指标(2015年版)的通知. (2015-04-10)[2019-11-20]. http://www.nhc.gov.cn/wjw/pyzl/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
10. Thom KA, Johnson JK, Lee MS, et al. Environmental contamination because of multidrug-resistant Acinetobacter baumannii surrounding colonized or infected patients. Am J Infect Control, 2011, 39(9): 711-715.
11. Ryu SY, Baek WK, Kim HA. Association of biofilm production with colonization among clinical isolates of Acinetobacter baumannii. Korean J Intern Med, 2017, 32(2): 345-351.
12. Ketter PM, Yu JJ, Guentzel MN, et al. Acinetobacter baumannii gastrointestinal colonization is facilitated by secretory IgA which is reductively dissociated by bacterial thioredoxin A. MBio, 2018, 9(4): e01298-18.
13. 张银维, 周华, 蔡洪流, 等. 鲍曼不动杆菌血流感染临床特征和死亡危险因素分析. 中华内科杂志, 2016, 55(2): 121-126.
14. Pu L, Jian Z, Pan F, et al. Comparative genomic analysis and multi-drug resistance differences of Acinetobacter baumannii in Chongqing, China. Infect Drug Resist, 2019, 12: 2827-2838.
15. Zhang X, Gu B, Mei Y, et al. Increasing resistance rate to carbapenem among blood culture isolates of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa in a university-affiliated hospital in China, 2004-2011. J Antibiot (Tokyo), 2015, 68(2): 115-120.
16. 韩静静, 邓艳萍, 高鑫, 等. ICU 中革兰阴性菌血流感染的危险因素分析. 重庆医学, 2016, 45(12): 1638-1640, 1644.
17. Guo N, Xue W, Tang D, et al. Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China. Am J Infect Control, 2016, 44(4): e37-e39.
18. 张青, 王小亭, 张宏民, 等. 重症临床急性生理学及慢性健康状况系统评分与人工评分的比较. 中华医学杂志, 2015, 95(39): 3173-3175.

West China Medical Journal

Prognostic risk factors associated with bloodstream infections caused by Acinetobacter baumannii

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