Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

Abstract

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

Phage-antibiotic combination is a superior treatment against Acinetobacter baumannii in a preclinical study

“…We had previously determined a starting bacterial inoculum of mid-10 6 CFU per mouse consistently produced a 100% lethality rate without effective treatment at 12 h, 33 mirroring the severity of A. baumannii bacteraemia in humans. 47 , 48 First we compared the effect of once-a-day (q.d.) versus twice-a-day (b.i.d) intraperitoneal (IP) administration of phages on animal bodyweight and average bacterial and phage counts at 24 hpi.…”

The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

“…The only drugs that exhibited fairly low overall resistance rates were linezolid and colistin. Linezolid resistance across Europe and worldwide remains low [23,24], but colistin-resistant HAIs in ICUs are becoming a concern [25,26]. Colistin plays a crucial role in treatment of MDR infections, and efforts toward determining colistin resistance on a larger scale are ongoing [27].…”

Insights into Acinetobacter baumannii: A Review of Microbiological, Virulence, and Resistance Traits in a Threatening Nosocomial Pathogen

“…In a recent study from a hospital in Northwest Ethiopia, A. baumannii accounted for about 9% of nosocomial bloodstream infections, and were 100% resistant to ampicillin and piperacillin, and 33.3% and 44.5% resistant to meropenem and ciprofloxacin, respectively [42]. Moreover, 42% of A. baumannii causing bloodstream infections in ICU patients from a Greek university hospital were resistant to colistin, and were directly linked to fulminant septic shock and high mortality [43]. Such wealth of data regarding the upsurge of drug-resistant A. baumannii in bloodstream infections, especially in severely ill patients, requires emphasis on surveillance and characterization of antimicrobial resistance patterns, as well as reinforcement of appropriate antibiotic and infection control measures.…”