Clinical analysis and trend in antimicrobial resistance of <i>Acinetobacter baumannii</i> bloodstream infection in a tertiary hospital from 2010 to 2016 _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TAN Jianlong ¹ , ZHANG Weidong ¹ , XIE Liangyi ² ,  LIU Zhiguang ¹

1. Department of Respiratory Medicine, Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P. R. China;
2. Department of Laboratory Medicine, Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P. R. China;

Corresponding author：

LIU Zhiguang, Email: liuzhiguang0404@126.com

Keywords：

Acinetobacter baumannii; Bloodstream infection; Drug resistance; Antimicrobial agent

DOI：

10.7507/1671-6205.201710026

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Objective To review the clinical features and trend in antimicrobial resistance of Acinetobacter baumannii (A. baumannii) bloodstream infections. Methods Retrospective analysis was performed by collecting data of underlying diseases, potential risk factors, clinical characteristics, blood test results, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores at onset, bacterial resistance to antibiotics and antimicrobial therapy were collected in Hunan Provincial People’s Hospital from January 2010 to June 2016. Results There were 114 non-duplicated A. baumannii complex blood isolates identified in this research. All patients had at least one underlying disease and accepted at least one surgery or invasive operation within the past 14 days. Multidrug-resistant A. baumannii (MDRAB) was isolated from 89 (78.1%) patients. Of the 114 strains of A. baumannii, 12.3% were resistant to tigecycline, 55.3% to amikacin and 61.4% to cefoperazone-sulbactam. The overall mortality was 51.8% (59/114). The patients with MDRAB had higher mortality rate than those with non-MDRAB (62.9% vs. 12.0%, χ²=20.268, P<0.001). With higher incidence of being in the intensive care unit, intubation/tracheotomy and increased APACHEⅡ score among patients with MDRAB bacteremia (P<0.05). Compared with subjects treated with tigecycline based regimen, those treated with non tigecycline for multidrug resistantA. baumannii had a higher mortality (64.8% vs. 60.0%) but there was no statistical significance (P>0.05). Conclusions The isolated A. baumannii are mainly multidrug resistant and with high mortality. Being in the intensive care unit, increased APACHEⅡ score and intubation/tracheotomy were risk factors for higher mortality among patients with MDRAB bloodstream infection. Tigecycline based regimen doesn’t improve patients’ prognosis.

Citation： TAN Jianlong, ZHANG Weidong, XIE Liangyi, LIU Zhiguang. Clinical analysis and trend in antimicrobial resistance of Acinetobacter baumannii bloodstream infection in a tertiary hospital from 2010 to 2016 . Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(3): 237-242. doi: 10.7507/1671-6205.201710026 Copy

1.	吕媛, 李耘, 薛峰, 等. 卫生部全国细菌耐药监测网(Mohnarin) 2011-2012 年度血流感染细菌耐药监测报告. 中国临床药理学杂志, 2014, 30(3): 278-288.
2.	李军, 刘清霞, 黄泽炳, 等. 某医院感染病区 2011-2015 年临床分离病原菌及其耐药性. 中国感染控制杂志, 2016, 15(7): 471-475.
3.	何禄娟, 孟婕, 黄大毛, 等. ICU 多重耐药鲍曼不动杆菌血流感染的回顾性分析. 中南大学学报(医学版), 2015, 40(12): 1327-1332.
4.	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.
5.	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.
6.	Gulen TA, Guner R, Celikbilek N, et al. Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii. Int J Infect Dis, 2015, 38(9): 32-35.
7.	胡付品, 朱德妹, 汪复, 等. 2015年 CHINET 细菌耐药性监测. 中国感染与化疗杂志, 2016, 16(6): 685-694.
8.	张密, 陈延斌. 鲍曼不动杆菌血流感染 136 例临床分析. 中国感染与化疗杂志, 2016, 16(4): 385-388.
9.	Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric in patients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control, 2015, 43(8): 857-860.
10.	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.
11.	廖纪萍, 孙立颖, 马靖, 等. 泛耐药鲍曼不动杆菌菌血症的临床特点及预后. 中国呼吸与危重监护杂志, 2017, 16(5): 436-440.
12.	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): 356-362.
13.	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.
14.	Liu Q, Li W, Du X, et al. Risk and prognostic factors for multidrug-resistant acinetobacter baumannii complex bacteremia: a retrospective study in a tertiary hospital of west China. PLoS One, 2015, 10(6): e0130701.
15.	Tsai MH, Chu SM, Hsu JF, et al. Polymicrobial bloodstream infection in neonates: microbiology, clinical characteristics, and risk factors. PLoS One, 2014, 9(1): e83082.
16.	Gu Z, Han Y, Meng T, et al. Risk factors and clinical outcomes for patients with Acinetobacter baumannii bacteremia. Medicine (Baltimore), 2016, 95(9): e2943.
17.	Chang YY, Liu YM, Liu CP, et al. Impact of reduced tigecycline susceptibility on clinical outcomes of Acinetobacter bacteremia. J Microbiol Immunol Infect, 2017. https://doi.org/10.1016/j.jmii.2017.08.024.
18.	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.
19.	Liou BH, Lee YT, Kuo SC, et al. Efficacy of tigecycline for secondary Acinetobacter bacteremia and factors associated with treatment failure. Antimicrob Agents Chemother, 2015, 59(6): 3637-3640.

1. 吕媛, 李耘, 薛峰, 等. 卫生部全国细菌耐药监测网(Mohnarin) 2011-2012 年度血流感染细菌耐药监测报告. 中国临床药理学杂志, 2014, 30(3): 278-288.
2. 李军, 刘清霞, 黄泽炳, 等. 某医院感染病区 2011-2015 年临床分离病原菌及其耐药性. 中国感染控制杂志, 2016, 15(7): 471-475.
3. 何禄娟, 孟婕, 黄大毛, 等. ICU 多重耐药鲍曼不动杆菌血流感染的回顾性分析. 中南大学学报(医学版), 2015, 40(12): 1327-1332.
4. 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.
5. 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.
6. Gulen TA, Guner R, Celikbilek N, et al. Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii. Int J Infect Dis, 2015, 38(9): 32-35.
7. 胡付品, 朱德妹, 汪复, 等. 2015年 CHINET 细菌耐药性监测. 中国感染与化疗杂志, 2016, 16(6): 685-694.
8. 张密, 陈延斌. 鲍曼不动杆菌血流感染 136 例临床分析. 中国感染与化疗杂志, 2016, 16(4): 385-388.
9. Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric in patients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control, 2015, 43(8): 857-860.
10. 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.
11. 廖纪萍, 孙立颖, 马靖, 等. 泛耐药鲍曼不动杆菌菌血症的临床特点及预后. 中国呼吸与危重监护杂志, 2017, 16(5): 436-440.
12. 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): 356-362.
13. 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.
14. Liu Q, Li W, Du X, et al. Risk and prognostic factors for multidrug-resistant acinetobacter baumannii complex bacteremia: a retrospective study in a tertiary hospital of west China. PLoS One, 2015, 10(6): e0130701.
15. Tsai MH, Chu SM, Hsu JF, et al. Polymicrobial bloodstream infection in neonates: microbiology, clinical characteristics, and risk factors. PLoS One, 2014, 9(1): e83082.
16. Gu Z, Han Y, Meng T, et al. Risk factors and clinical outcomes for patients with Acinetobacter baumannii bacteremia. Medicine (Baltimore), 2016, 95(9): e2943.
17. Chang YY, Liu YM, Liu CP, et al. Impact of reduced tigecycline susceptibility on clinical outcomes of Acinetobacter bacteremia. J Microbiol Immunol Infect, 2017. https://doi.org/10.1016/j.jmii.2017.08.024.
18. 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.
19. Liou BH, Lee YT, Kuo SC, et al. Efficacy of tigecycline for secondary Acinetobacter bacteremia and factors associated with treatment failure. Antimicrob Agents Chemother, 2015, 59(6): 3637-3640.

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Clinical analysis and trend in antimicrobial resistance of Acinetobacter baumannii bloodstream infection in a tertiary hospital from 2010 to 2016

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