Ten-Year Changes in Bloodstream Infection With Acinetobacter Baumannii Complex in Intensive Care Units in Eastern China: A Retrospective Cohort Study

Abstract

Background: There is little evidence on the changing prevalence, microbiological profile, and outcome of nosocomial Acinetobacter baumannii complex (ABC)-caused bloodstream infection (ABCBSI) specified in intensive care units (ICUs) in long-term studies, especially in China.Objective: We aimed to investigate changes in incidence, antibiotic resistance, therapy, and prognosis of ABCBSI in ICUs in eastern China during 2009–2018.Methods: A multicenter retrospective cohort study was conducted, and microbiological and clinical data for patients with ABCBSI acquired in nine adult ICUs in eastern China from 2009 to 2018.Results: A total of 202 cases were enrolled. For the years 2009–2010, 2011–2012, 2013–2014, 2015–2016, and 2017–2018, the incidence of ABCBSI increased significantly, as did the percentage of pan-drug-resistant isolates and resistant rates to most of antimicrobial agents; the percentage of drug-sensitive isolates decreased (all P < 0.05). The frequency of treatment with carbapenems and tigecycline increased, and that of cephalosporins decreased. Compared with those in the first years (2009–2012), ABCBSI patients in the lattermost years (2017–2018) were less often treated with appropriate empirical therapy, more often underwent pneumonia-related ABCBSI and mechanical ventilation support, and had higher 28-day mortality rates. Multivariate Cox regression indicated that increase in the degree of ABC antibiotics resistance, pneumonia-related ABCBSI, and septic shock were risk factors of 28-day mortality and associated with significant lower survival days.Conclusions: The past decade has witnessed a marked increase in the incidence of ABCBSI and in antibiotic resistance, with increasing pneumonia-related infections and worrisome mortality in ICUs in China. Controlling increasing resistance and preventing nosocomial pneumonia may play important roles in combatting these infections.

Comparison of pneumonia and nonpneumonia-related Acinetobacter baumannii complex bacteremia: A single-center retrospective study

“…21 A recent study revealed that the frequency of ABC bacteremia increased significantly in the ICUs in eastern China during 2009-2018, as did the resistance rate to carbapenem. 15 In this study, the resistance rate to imipenem was 95.7% in year 2017-2018, which is higher than in the CHINET data. We analyzed the clinical data of patients with ABC bacteremia during the past 12 years.…”

“…A recent retrospective cohort study of Chinese ICUs found that the incidence of ABC bacteremia and prevalence of antibiotic resistance increased markedly during the past decade, along with increasing pneumonia-related infections and worrisome mortality. 15 Therefore, we performed this single-center retrospective study to explore differences in clinical profile and prognosis between patients with pneumonia-and non-pneumonia-related ABC bacteremia, and identified possible independent risk factors for 30-day mortality.…”

Immunoinformatics Approaches for Developing Multi-Epitope Subunit Vaccines to Combat Acinetobacter Baumannii

“…What turned A. baumannii into an urgent threat is resistance to multiple antibiotics, especially carbapenems (Ramirez et al 2020), and the resistance mechanisms that A. baumannii has achieved consist of β-lactamases, aminoglycoside-modifying enzymes, permeability defects, e ux pumps, and target site modi cations (Kyriakidis et al 2021; Lee et al 2017). The infection of A. baumannii has caused great damage to public health worldwide, and the prevalence of infection could be 2%-4% among all medical-related infections and over 10% in the ICU (Lotsch et al 2020;Ma and McClean 2021;Meng et al 2021). A total of 1011 strains collected from 48 countries show that more than half of the strains are multidrug-resistant (MDR) (Lob et al 2016); unfortunately, it is estimated that the mortality of MDR baumannii is more than 50% (Ma and McClean 2021).…”

Acinetobacter baumannii among Patients Receiving Glucocorticoid Aerosol Therapy during Invasive Mechanical Ventilation, China

“…strains increased by 2.7-fold in 2018 compared with 2012 ( 23 , 24 ). Previously, we reported a marked increase in the incidence of A. baumannii– related bloodstream infections and incidence of pneumonia-related A. baumannii infections in ICUs in China that were 3.2-fold higher during 2017–2018 than during 2011–2012 ( 25 ). A. baumannii was the most frequent bacterial isolate in ventilator-associated pneumonia in China, and rates were 35.7%–52.7% ( 26 , 27 ).…”

“…According to CHINET reports, carbapenem-resistant A. baumannii strains increased from 31% in 2005 to 66.7% in 2014 ( 28 ), then to ≈80% in 2018 ( 29 ). We previously reported that carbapenem resistance rates in ICUs in China increased from 25% during 2011–2012 to 95.7% during 2017–2018 ( 25 ). A multicenter study of ICUs in China reported that multidrug-resistant (MDR) A. baumannii was detected in 40% of all cases ( 30 ).…”