Clinical characteristics and prognosis of extensively drug-resistant <i>Acinetobacter baumannii</i> bacteremia _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIAO Jiping ¹ , QUE Chengli ¹ , SUN Liying ² , JIN Zhe ¹ ,  MA Jing ¹ , WANG Guangfa ¹

1. Department of Pulmonary and Critical Care Medicine, Peking University First Hospital, Beijing 100034, P. R. China;
2. Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, P. R. China;

Corresponding author：

MA Jing, Email: majjmail@163.com

Keywords：

Acinetobacter baumannii; Extensively drug-resistant bacteremia; Prognosis

DOI：

10.7507/1671-6205.201612055

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Objective To summarize the clinical features and prognosis of extensively drug-resistant Acinetobacter baumannii (XDRAB) bacteremia. Methods This retrospective study included patients with Acinetobacter baumannii bacteremia diagnosed and treated in RICU of this hospital during January 1, 2012 and December 31, 2015. Demographic features, clinical data, clinical outcome within 3 days and 14 days after sample collection for blood culture were collected. Results Eight patients were included, with the mean age of (62.4±18.0) years, and including 3 males and 5 females. All patients had underlying diseases, 6 patients were immune suppressed, 7 patients had been exposed to β-lactam/enzyme inhibition or carbapenems for at least 7 days within 2 weeks before blood sample collection, and 6 patients received mechanical ventilation. Lung is the main pathogen source (6 cases). Within 48 hours after blood collection, the mean acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score was 28.3±7.5, the level of serum C-reactive protein (18.2 to 231.0 mg/L) and procalcitonin (0.1 to 25.0 ng/ml) had individual differences. The 3-day mortality rate was 4/8, the death group had APACHEⅡ >25. The 14-day mortality rate was 6/8, all the patients with procalcitionin>0.5 ng/ml died. Conclusions The 14-Day mortality is associated with the severity and increased procalcitionin in XDRAB patients. Preemptive therapy is recommend for patients with multiple risk factors, receiving mechanical ventilation, and with elevated procalcitonin and high APACHEⅡ score ( >25).

Citation： LIAO Jiping, QUE Chengli, SUN Liying, JIN Zhe, MA Jing, WANG Guangfa. Clinical characteristics and prognosis of extensively drug-resistant Acinetobacter baumannii bacteremia . Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(5): 436-440. doi: 10.7507/1671-6205.201612055 Copy

1.	赵春江, 陈宏斌, 王辉, 等. 2013 年全国 13 所教学医院院内血流感染及院内获得性肺炎和院内获得性腹腔感染常见病原菌分布和耐药性研究. 中华医学杂志, 2015, 95(22): 1739-1746.0.
2.	陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中华医学杂志, 2012, 92(2): 76-85.0.
3.	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.
4.	Lee HY, Chen CL, Wu SR, et al. Risk factors and outcome analysis of acinetobacter baumannii complex bacteremia in critical patients. Crit Care Med, 2014, 42(5): 1081-1088.
5.	Huang ST, Chiang MC, Kuo SC, et al. Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2012, 45(5): 356-62.
6.	Anunnatsiri S, Tonsawan P. Risk factors and clinical outcomes of multidrug-resistant Acinetobacter baumannii bacteremia at a university hospital in Thailand. Southeast Asian J Trop Med Public Health, 2011, 42(3): 693-703.
7.	Routsi C, Pratikaki M, Platsouka E, et al. Carbapenem-resistant versus carbapenem-susceptible Acinetobacter baumannii bacteremia in a Greek intensive care unit: risk factors, clinical features and outcomes. Infection, 2010, 38(3): 173-180.
8.	Shih MJ, Lee NY, Lee HC, et al. Risk factors of multidrug resistance in nosocomial bacteremia due to Acinetobacter baumannii: a case-control study. J Microbiol Immunol Infect, 2008, 41(2): 118-123.
9.	Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric inpatients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control, 2015, 43(8): 857-860.
10.	Kim YJ, Kim SI, Hong KW, et al. Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia: Impact of Appropriate Antimicrobial Therapy. J Korean Med Sci, 2012, 27(5): 471-475.
11.	Lee YT, Kuo SC, Yang SP, et al. Impact of appropriate antimicrobial therapy on mortality associated with Acinetobacter baumannii bacteremia: relation to severity of infection. Clin Infect Dis, 2012, 55(2): 209-215..
12.	Teng SO, Yen MY, Ou TY, et al. Comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii bacteremia: Impact on empiric therapy and antibiotic resistance. J Microbiol Immunol Infect, 2015, 48(5): 525-30.
13.	Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLoS One, 2015, 10(7): e0132109.
14.	Chuang YC, Chang SC, Wang WK. High and increasing Oxa-51 DNA load predict mortality in Acinetobacter baumannii bacteremia: implication for pathogenesis and evaluation of therapy. PLoS One, 2010, 5(11): e14133.
15.	Chuang YC, Sheng WH, Li SY, et al. Influence of genospecies of Acinetobacter baumannii complex on clinical outcomes of patients with acinetobacter bacteremia. Clin Infect Dis, 2011, 52(3): 352-360.
16.	Lee NY, Chang TC, Wu CJ, et al. Clinical manifestations, antimicrobial therapy, and prognostic factors of monomicrobial Acinetobacter baumannii complex bacteremia. J Infect, 2010, 61(3): 219-227.
17.	降钙素原急诊临床应用专家共识组. 降钙素原 (PCT) 急诊临床应用的专家共识. 中华急诊医学杂志, 2012, 21(9): 944-951.0.
18.	隆云, 郭清华, 刘大为, 等. 泛耐药鲍曼不动杆菌菌血症危险因素及临床结局. 协和医学杂志, 2015, 6(4): 260-266.0.
19.	Cheng A, Chuang YC, Sun HY, et al. Excess Mortality Associated With Colistin-Tigecycline Compared With Colistin-Carbapenem Combination Therapy for Extensively Drug-Resistant Acinetobacter baumannii Bacteremia: A Multicenter Prospective Observational Study. Crit Care Med, 2015, 43(6): 1194-1204.

1. 赵春江, 陈宏斌, 王辉, 等. 2013 年全国 13 所教学医院院内血流感染及院内获得性肺炎和院内获得性腹腔感染常见病原菌分布和耐药性研究. 中华医学杂志, 2015, 95(22): 1739-1746.0.
2. 陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中华医学杂志, 2012, 92(2): 76-85.0.
3. 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.
4. Lee HY, Chen CL, Wu SR, et al. Risk factors and outcome analysis of acinetobacter baumannii complex bacteremia in critical patients. Crit Care Med, 2014, 42(5): 1081-1088.
5. Huang ST, Chiang MC, Kuo SC, et al. Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2012, 45(5): 356-62.
6. Anunnatsiri S, Tonsawan P. Risk factors and clinical outcomes of multidrug-resistant Acinetobacter baumannii bacteremia at a university hospital in Thailand. Southeast Asian J Trop Med Public Health, 2011, 42(3): 693-703.
7. Routsi C, Pratikaki M, Platsouka E, et al. Carbapenem-resistant versus carbapenem-susceptible Acinetobacter baumannii bacteremia in a Greek intensive care unit: risk factors, clinical features and outcomes. Infection, 2010, 38(3): 173-180.
8. Shih MJ, Lee NY, Lee HC, et al. Risk factors of multidrug resistance in nosocomial bacteremia due to Acinetobacter baumannii: a case-control study. J Microbiol Immunol Infect, 2008, 41(2): 118-123.
9. Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric inpatients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control, 2015, 43(8): 857-860.
10. Kim YJ, Kim SI, Hong KW, et al. Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia: Impact of Appropriate Antimicrobial Therapy. J Korean Med Sci, 2012, 27(5): 471-475.
11. Lee YT, Kuo SC, Yang SP, et al. Impact of appropriate antimicrobial therapy on mortality associated with Acinetobacter baumannii bacteremia: relation to severity of infection. Clin Infect Dis, 2012, 55(2): 209-215..
12. Teng SO, Yen MY, Ou TY, et al. Comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii bacteremia: Impact on empiric therapy and antibiotic resistance. J Microbiol Immunol Infect, 2015, 48(5): 525-30.
13. Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLoS One, 2015, 10(7): e0132109.
14. Chuang YC, Chang SC, Wang WK. High and increasing Oxa-51 DNA load predict mortality in Acinetobacter baumannii bacteremia: implication for pathogenesis and evaluation of therapy. PLoS One, 2010, 5(11): e14133.
15. Chuang YC, Sheng WH, Li SY, et al. Influence of genospecies of Acinetobacter baumannii complex on clinical outcomes of patients with acinetobacter bacteremia. Clin Infect Dis, 2011, 52(3): 352-360.
16. Lee NY, Chang TC, Wu CJ, et al. Clinical manifestations, antimicrobial therapy, and prognostic factors of monomicrobial Acinetobacter baumannii complex bacteremia. J Infect, 2010, 61(3): 219-227.
17. 降钙素原急诊临床应用专家共识组. 降钙素原 (PCT) 急诊临床应用的专家共识. 中华急诊医学杂志, 2012, 21(9): 944-951.0.
18. 隆云, 郭清华, 刘大为, 等. 泛耐药鲍曼不动杆菌菌血症危险因素及临床结局. 协和医学杂志, 2015, 6(4): 260-266.0.
19. Cheng A, Chuang YC, Sun HY, et al. Excess Mortality Associated With Colistin-Tigecycline Compared With Colistin-Carbapenem Combination Therapy for Extensively Drug-Resistant Acinetobacter baumannii Bacteremia: A Multicenter Prospective Observational Study. Crit Care Med, 2015, 43(6): 1194-1204.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical characteristics and prognosis of extensively drug-resistant Acinetobacter baumannii bacteremia

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