TY - JOUR
T1 - Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients From Different Global Regions
AU - Multi-Drug Resistant Organism Network Investigators
AU - Wang, Minggui
AU - Ge, Lizhao
AU - Chen, Liang
AU - Komarow, Lauren
AU - Hanson, Blake
AU - Reyes, Jinnethe
AU - Cober, Eric
AU - Alenazi, Thamer
AU - Zong, Zhiyong
AU - Xie, Qing
AU - Liu, Zhengyin
AU - Li, Lanjuan
AU - Yu, Yunsong
AU - Gao, Hainv
AU - Kanj, Souha S.
AU - Figueroa, Jairo
AU - Herc, Erica
AU - Cordova, Ezequiel
AU - Weston, Gregory
AU - Tambyah, Paul Ananth
AU - Garcia-Diaz, Julia
AU - Kaye, Keith S.
AU - Dhar, Sorabh
AU - Munita, Jose M.
AU - Salata, Robert A.
AU - Vilchez, Samuel
AU - Stryjewski, Martin E.
AU - Botero, Maria Virginia Villegas
AU - Iovleva, Alina
AU - Evans, Scott R.
AU - Baum, Keri
AU - Hill, Carol
AU - Kreiswirth, Barry N.
AU - Patel, Robin
AU - Paterson, David L.
AU - Arias, Cesar A.
AU - Bonomo, Robert A.
AU - Chambers, Henry F.
AU - Fowler, Vance G.
AU - Satlin, Michael J.
AU - van Duin, David
AU - Doi, Yohei
AU - Zhang, Fujie
AU - Lok, Judith J.
AU - Di Castelnuovo, Valentina
AU - Gutierrez, Jose Millan Oñate
AU - Richter, Susan
AU - Anderson, Deverick J.
AU - Evans, Beth
AU - Panesso, Diana
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved.
PY - 2024/2/15
Y1 - 2024/2/15
N2 - BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.METHODS: In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis.RESULTS: Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases.CONCLUSIONS: CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinical Trials Registration. NCT03646227.
AB - BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.METHODS: In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis.RESULTS: Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases.CONCLUSIONS: CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinical Trials Registration. NCT03646227.
KW - carbapenem-resistant Acinetobacter baumannii
KW - clinical impact
KW - international epidemiology
KW - Microbial Sensitivity Tests
KW - Carbapenems/pharmacology
KW - Acinetobacter baumannii/genetics
KW - Bacterial Proteins/genetics
KW - Prospective Studies
KW - Humans
KW - Acinetobacter Infections/drug therapy
KW - beta-Lactamases/genetics
KW - Anti-Bacterial Agents/pharmacology
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U2 - 10.1093/cid/ciad556
DO - 10.1093/cid/ciad556
M3 - Article
C2 - 37738153
SN - 1058-4838
VL - 78
SP - 248
EP - 258
JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
IS - 2
ER -