Objective To investigate the drug resistance and homogeneous analysis of Acinetobacter baumanii in emergency intensive care unit ( EICU) . Methods Four multidrug-resistant Acinetobacter baumannii ( MDR-Ab) strains isolated fromnosocomial inpatients fromJuly 25 to September 7 in 2009 were collected and tested for drug sensitivity and MIC determination as well. The A. baumannii isolates were typed with pulsed-field gel electrophoresis ( PFGE) to determine whether they derived fromthe same clone.Results Four isolates from nosocomial inpatients were resistant to multiple antibiotics including carbapenem. The PFGE types identified from four isolates were A and B. The A. baumannii isolates did not derived from the same clone. Conclusion The prevalence of nosocomial infection is not due to transmission of the same strains among different individuals in EICU.
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.
ObjectiveTo investigate the clinical characteristics, treatment and outcomes of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis.MethodsWe retrospectively analyzed the clinical data of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis in the First Affiliated Hospital of Airforce Military University from January 2011 to December 2018. The clinical baseline data, treatment process, microbiological data, antibiotic susceptibility test of the bacterial isolates and outcomes were analyzed.ResultsA total of 10 patients were enrolled, including 4 males and 6 females. The average age of all patients was (44.90±17.03) years, the average age of peritoneal dialysis was (21.70±17.06) months. Seven cases were infected for the first time, and 3 cases were reinfected. The infections were mainly caused by mechanical failure of catheter connection system (3 cases) or enterogenous infection (3 cases). The main symptoms were abdominal pain (10 cases), fever (7 cases) and diarrhea (3 cases). Empirical anti-infective treatment was given after admission, only 1 case was effective, and the treatment of the other 9 cases were adjusted according to the results of drug sensitivity. Acinetobacter baumannii was sensitive to cefoperazone, carbapenem (meropenem, imipenem), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin) and polymyxin. Only one case was resistant to ceftazidime. Among the 10 patients, 8 cases were cured (continued peritoneal dialysis), 1 case died, and 1 case dropped out from peritoneal dialysis to hemodialysis.ConclusionsAcinetobacter baumannii peritoneal dialysis-related peritonitis in this hospital is mainly caused by mechanical disturbance of catheter connection system or enterogenic infection. Appropriate measures, including aseptic standard operation, follow-up and effective anti-infective treatment, should be taken to decrease the incidence and mortality of Acinetobacter baumannii peritoneal dialysis-related peritonitis.
ObjectiveTo evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) level in bronchoalveolar lavage fluid (BALF) for discrimination of Acinetobacter baumannii (A. baumannii) colonization from infection.MethodsSixty patients with tracheal intubation or tracheotomy who were admitted in intensive care unit from July 2016 to July 2018, were divided into an infection group (n=20), a colonization group (n=20) and a control group (n=20). The serum and BALF samples were collected from the patients on the day when lower respiratory tract sample culture was positive so as to detect sTREM-1, serum procalcitonin (PCT) and interleukin-6 (IL-6). The value of serum PCT, IL-6, sTREM-1 and BALF sTREM-1 in differentiation of infection or colonization for A. baumannii was analyzed by mean of receiver operating characteristic (ROC) curve.ResultsThere were no significant differences in gender composition, age or Glasgow coma score among the three groups (P>0.05). The clinical pulmonary infection score (CPIS) of the infection group was higher than that in the control group (P<0.05). Compared with the control group, while the sTREM-1 concentration of BALF with A. baumannii colonization increased significantly but levels of PCT, IL-6 and sTREM-1 remained unchanged in serum. The levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.001). Compared with the colonization group, the levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.05). The area under the ROC curve (AUC) of serum PCT was 0.67 with the sensitivity of 0.55 and the specificity of 0.90 (95%CI 0.52 - 0.82). AUC of serum IL-6 was 0.72 with the sensitivity of 0.60 and the specificity of 0.95 (95%CI 0.58 - 0.85). AUC of serum sTREM-1 was 0.72 with the sensitivity of 0.75 and the specificity of 0.60 (95%CI 0.55 - 0.85). AUC of sTREM-1 in BALF was 0.92 with the sensitivity of 0.95 and the specificity of 0.70 (95%CI 0.79 - 0.98). The diagnostic accuracy of sTREM-1 in BALF was higher than that of PCT, IL-6 and sTREM-1 in serum (P<0.05).ConclusionssTREM-1 in BALF has good diagnostic performance in differentiating patients with infection of colonization for A. baumannii. Its sensitivity and specificity are higher than serum PCT, IL-6 and sTREM-1.
Objective To evaluate the efficacy and safety of colistin in the treatment of severe infections. Methods PubMed, ISI Web of Knowledge and Wanfang databases were searched. The initial literatures and references listed in the literature were manually searched. Controlled studies were analyzed using RevMan 5. 0 software.Results Eleven studies were enrolled, including five prospective studies and six retrospective studies. Pooled analysis showed that, compared with other therapies, treatment with colistin in severe infections did not improve 28 or 30-day mortality, clinical symptoms, or bacteria clearance,however, increased the risk of kidney damage. Subgroup analysis showed that colistin did not improve symptoms, mortality ( which was even higher in the patients with drug resistant bacteria infection) , or kidney damage in drug resistant bacteria infections and ventilator associated pneumonia ( VAP) compared with the other antibiotic group. Conclusions Colistin is not superior to the other antibiotics in severe infections.However, there are some shortcomings in our meta-analysis due to limited high-quality RCTs, thus welldesigned RCTs are still needed before final conclusion is made.
ObjectiveTo investigate clinical characteristics and influencing factors of lower respiratory tract infection of Acinetobacter baumannii (AB-LRTI) in respiratory intensive care unit (RICU).MethodsClinical data were collected from 204 RICU patients who were isolated Acinetobacter baumannii (AB). The bacteriological specimens were derived from sputum, bronchoscopic endotracheal aspiration, bronchoalveolar lavage fluid, pleural effusion and blood. The definition of bacterial colonization was based on the responsible criteria from Centers for Disease Control and Prevention/National Medical Safety Network (CDC/NHSN). The patients were divided into three groups as follows, AB colonization group (only AB was isolated, n=40); simple AB-LRTI group (only AB was isolated and defined as infection, n=63), AB with another bacteria LRTI group (AB and another pathogen were isolated simultaneously, n=101). The epidemiology, clinical characteristics and influencing factors of each group were analyzed and compared. ResultsCompared with the AB colonization group, the AB with another bacteria LRTI group had higher proportion of patients with immunosuppression, specimens from sputum and bronchoalveolar lavage fluid, more than 4 invasive procedures, 90-day mortality, white blood cell count >10×109/L (or <4×109/L), neutrophil percent >75% (or <40%), lymphocyte count <1.1×109/L, platelet count <100×109/L, albumin <30 g/L, high sensitivity C-reactive protein >10 mg/L, and neutrophil-to-lymphocyte ratio (NLR). The frequency of bronchoscopy and days of infusing carbapenem within 90 days before isolating AB, the Acute Physiology and Chronic Health Evaluation Ⅱ score, the proportion of patients with invasive mechanical ventilation and the duration of invasive mechanical ventilation in the AB with another pathogen LRTI group were higher than those in the AB colonization group (all P<0.05). Days of infusing carbapenem and β-lactams/β-lactamase inhibitors within 90 days before isolating AB, proportion of septic shock, NLR and 90-day mortality of the patients from the AB with another pathogen LRTI group were more than those in the simple AB-LRTI group (all P<0.05). After regression analysis, more than 4 invasive procedures, or immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB were all the independent risk factors for AB-LRTI.ConclusionsThere are significant differences in epidemiology, clinical symptoms and laboratory indicators between simple AB-LRTI, AB with another pathogen LRTI and AB colonization in RICU patients. For RICU patients, who suffered more than 4 invasive procedures, immunosuppression, or with more days of infusing carbapenem within 90 days before isolating AB, are more susceptible to AB-LRTI.
Objective To analyze the clinical characteristics, mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii (CRAB), so as to provide references for the prevention and control of CRAB. Methods Inpatients with Acinetobacter baumannii were selected from the clinical samples in the intensive care unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital between January 2018 and December 2021. The patients were divided into CRAB infection group, carbapenem-sensitive Acinetobacter baumannii (CSAB) infection group and CRAB colonization group. Survival analysis was used to analyze the mortality risk and its influencing factors in patients with CRAB infection. Results A total of 696 patients were included. Among them, there were 392 cases of CRAB infection, 267 cases of CRAB colonization, and 37 cases of CSAB infection. The factors that increased the 30-day mortality risk of CRAB mainly included blood transfusion or use of blood products, mechanical ventilation, respiratory failure, maximum procalcitonin and age. Kaplan-Meier analysis showed that the 30-day mortality risk of CRAB infection group was higher than that of CSAB infection group（χ2=4.837, P=0.028), there was no significant difference between CRAB infection group and CRAB colonization group in 30-day mortality risk（χ2=0.219, P=0.640). Conclusions The mortality risk of CRAB infected patients is higher. Compared with the infection status, the 30-day mortality risk of patients is more attributed to drug resistance status. The effective method to control the mortality rate of CRAB should focus on reducing the hospital acquisition rate of CRAB.
Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.ResultsA total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.
Intracranial Acinetobacter baumannii infection is a rare clinical disease with a gradual increase in incidence and extremely high mortality. With the continuous enhancement of bacterial resistance, more and more intracranial infections of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii have appeared in the clinic, and its treatment has become a major challenge and problem faced by neurosurgeons. The treatment difficulties include the selection, usage and dosage of antimicrobial agents, as well as whether cerebrospinal fluid drainage is needed. A standardized treatment plan is still needed. In this paper, combining domestic and foreign literature, the treatment of intracranial infection of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii will be reviewed in order to provide a reference for clinical treatment.
目的 探讨鲍曼不动杆菌感染的临床分布及药敏情况。 方法 对2009年1月－2011年12月的微生物送检标本进行统计分析，鲍曼不动杆菌2009年培养出19株，2010年29株（多重耐药菌株1株），2011年35株（多重耐药菌株2株），并对其分布的标本类型、科室及耐药情况进行分析。 结果 鲍曼不动杆菌在痰中检出率最高；科室分布依次为重症监护室（ICU）、神经外科、呼吸科；该菌对亚胺培南敏感性最高，对青霉素和头孢类抗生素耐药率均在55%以上。 结论 鲍曼不动杆菌感染患者的经验性抗生素治疗应根据其地区、医院最新的院内感染病原体分布及耐药性，合理选择抗生素；病情、高龄、免疫抑制剂、机械通气、多种侵入性操作及抗生素的使用为鲍曼不动杆菌医院感染危险因素；ICU存在多重耐药鲍曼不动杆菌的感染，应加以控制。