Multi-resistant Acinetobacter baumannii on a burns unit—clinical risk factors and prognosis

Wong, Ting Hway; Tan, Ban Hock; Ling, Moi Lin; Song, Colin

doi:10.1016/s0305-4179(02)00012-8

Cited by 64 publications

(58 citation statements)

References 25 publications

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“…baumannii [15]. Environmental risk factors such as intubation [16], prior surgery [17], and length of stay in the ICU [18] can lead to the development of MDR in A. baumannii.…”

Section: Introductionmentioning

confidence: 99%

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

Vaze¹,

Emery²,

Hamilton³

et al. 2013

AID

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A characterization of the clinical demographic features of patients with infection caused Acinetobacter baumannii, and the antibiotyping of the isolates recovered from these patients was undertaken, with a special reference to carbapenemresistant variants, and their risk factors. This study was conducted retrospectively from January 2010 to March 2011 at a 616-bed tertiary care university hospital. Sixty-four patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk and odds ratio. We identified 100 A. baumannii from 64 patients during 15 months period. Significant risk factors were working age (18 -60 years), male gender, hospital stay (>1 week but <1 month), prior hospitalization, in a progressive care nursing units, respiratory/mechanical ventilation, polymicrobial infections and prior antibiotic therapy. Methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumoniae were the significant co-infecting agents. The antibiogram demonstrated multidrug resistance in a majority of the isolates. Relative risk associated with ventilator, diabetes, and surgery was higher in repeat isolates than in first isolates and were multidrug resistant. Repeat isolates were more resistant that the first isolates to most anti-acinetobacter agents, but the overall crude mortality was not significant during this study period, and couldn't correlated to the choice of treatment. In conclusion, a resistance against all clinically used carbapenems, and colistin is rapidly increasing in repeat isolates of A. baumannii; leaves narrow therapeutic options to treat multidrug-resistant and pandrug-resistant A. baumannii infection. For the first time we report rising incidence of colistin resistance by 20 percent in repeat isolates, and is worrisome for healthcare centers. A combination therapy should be adopted to treat such infection to avoid the emergence of colistin-resistant phenotypes in the United States.

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“…baumannii [15]. Environmental risk factors such as intubation [16], prior surgery [17], and length of stay in the ICU [18] can lead to the development of MDR in A. baumannii.…”

Section: Introductionmentioning

confidence: 99%

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

Vaze¹,

Emery²,

Hamilton³

et al. 2013

AID

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“…It is also common in soil and freshwater environments (4,5). The bacterium has recently emerged to be an important nosocomial pathogen that causes pneumonia, septicemia, urinary tract infections, and meningitis (6).…”

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confidence: 99%

The Acinetobacter baumannii Omp33-36 Porin Is a Virulence Factor That Induces Apoptosis and Modulates Autophagy in Human Cells

et al. 2014

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Acinetobacter baumannii is an extracellular opportunistic human pathogen that is becoming increasingly problematic in hospitals. In the present study, we demonstrate that the A. baumannii Omp 33-to 36-kDa protein (Omp33-36) is a porin that acts as a channel for the passage of water. The protein is found on the cell surface and is released along with other porins in the outer membrane vesicles (OMVs). In immune and connective cell tissue, this protein induced apoptosis by activation of caspases and modulation of autophagy, with the consequent accumulation of p62/SQSTM1 (sequestosome 1) and LC3B-II (confirmed by use of autophagy inhibitors). Blockage of autophagy enables the bacterium to persist intracellularly (inside autophagosomes), with the subsequent development of cytotoxicity. Finally, we used macrophages and a mouse model of systemic infection to confirm that Omp33-36 is a virulence factor in A. baumannii. Overall, the study findings show that Omp33-36 plays an important role in the pathogenesis of A. baumannii infections.

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“…Increasingly, multidrug resistance strains of A. baumannii have become common in hospitals worldwide and especially in intensive care units (10, 12, 30) and burn units (2,31,32,40). The types of resistance include many commonly used antibiotics such as aminoglycosides, fluoroquinolones, and ␤-lactams, although carbapenems are the most used antimicrobial drugs.…”

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confidence: 99%

An OXA-66/OXA-51-Like Carbapenemase and Possibly an Efflux Pump Are Associated with Resistance to Imipenem in Acinetobacter baumannii

Hu¹,

Yao²,

Fung³

et al. 2007

Antimicrob Agents Chemother

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We investigated the mechanisms involved in imipenem resistance in 23 clinical strains of Acinetobacter baumannii. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis showed the presence of a 30-kDa protein in imipenem-intermediate A. baumannii (IIAB) and imipenem-resistant A. baumannii (IRAB) strains; this protein was almost undetectable in imipenem-susceptible A. baumannii (ISAB) strains. The 30-kDa protein was identified as an OXA-51-like carbapenemase using two-dimensional gel electrophoresis and mass spectrometry. Similar to other recent findings, bla OXA-51-like genes were found to exist in all 23 clinical strains; however, the transcript levels of bla OXA-51-like in the IIAB and IRAB were higher than in the ISAB strains using reverse transcriptase PCR (RT-PCR) and real-time RT-PCR assays. This change was due to the presence of an insertion sequence, ISAba1, upstream of bla OXA-51-like in the IIAB and IRAB strains that was not present in the ISAB strains. The introduction of bla OXA-66 (a bla OXA-51-like gene), identified in ISAB ab1254 and IRAB ab1266, into Escherichia coli TOP10 cells resulted in 3.95-fold and 7.90-fold elevations in resistance to imipenem, respectively. Furthermore, when ISAB ab8 and ISAB ab1254 and their in vitro-selected imipenem-resistant mutants ISAB ab8(r) and ISAB ab1254(r) were compared, the results showed no change in the bla OXA-66 /bla OXA-51-like gene sequences, in expression of the gene, and in the outer membrane protein profiles. However, there was a four-to eightfold reduction in imipenem resistance upon adding carbonyl cyanide m-chlorophenylhydrazone. Taken together, these results suggest that the OXA-66/OXA-51-like carbapenemase contributes to intrinsic resistance to imipenem; however, drug export by an efflux pump may be more important and/or occur more frequently in imipenem-resistant A. baumannii. Furthermore, this is the first report of a Taiwanese strain of an OXA-66/OXA-51-like carbapenemase that confers imipenem resistance in A. baumannii.Acinetobacter baumannii accounts for a large percentage of nosocomial infections including pneumonia, bacteremia, skin infections, wound infections, and urinary tract infections (2, 19). Increasingly, multidrug resistance strains of A. baumannii have become common in hospitals worldwide and especially in intensive care units (10, 12, 30) and burn units (2,31,32,40). The types of resistance include many commonly used antibiotics such as aminoglycosides, fluoroquinolones, and ␤-lactams, although carbapenems are the most used antimicrobial drugs. However, an increasing number of recent studies reported the emergence of clinical A. baumannii strains that are resistance to imipenem (7,9,27).The mechanism of resistance to carbapenems in A. baumannii has mostly been ascribed to the acquisition of carbapenemases (1, 26) or to synergistic effects between ␤-lactamases with an ability to hydrolyze carbapenems and decreased expression of certain penicillin-binding proteins (13,14). The carbapenemases in A. baumannii ...

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Multi-resistant Acinetobacter baumannii on a burns unit—clinical risk factors and prognosis

Cited by 64 publications

References 25 publications

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

The Acinetobacter baumannii Omp33-36 Porin Is a Virulence Factor That Induces Apoptosis and Modulates Autophagy in Human Cells

An OXA-66/OXA-51-Like Carbapenemase and Possibly an Efflux Pump Are Associated with Resistance to Imipenem in Acinetobacter baumannii

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Multi-resistant Acinetobacter baumannii on a burns unit—clinical risk factors and prognosis

Cited by 64 publications

References 25 publications

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; in a Teaching Hospital from the United States

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; in a Teaching Hospital from the United States

The Acinetobacter baumannii Omp33-36 Porin Is a Virulence Factor That Induces Apoptosis and Modulates Autophagy in Human Cells

An OXA-66/OXA-51-Like Carbapenemase and Possibly an Efflux Pump Are Associated with Resistance to Imipenem in Acinetobacter baumannii

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Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant <i>Acinetobacter baumannii</i> in a Teaching Hospital from the United States