Clinical Outcomes and Bacterial Characteristics of Carbapenem-Resistant Acinetobacter baumannii Among Patients from Different Global Regions.

Autor:	Wang M; Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China., Ge L; The Biostatistics Center, George Washington University, Rockville, MD, USA., Chen L; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA.; Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA., Komarow L; The Biostatistics Center, George Washington University, Rockville, MD, USA., Hanson B; Center for Infectious Diseases and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, TX, USA., Reyes J; Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia., Cober E; Department of Infectious Diseases, Cleveland Clinic, OH, USA., Alenazi T; College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia., Zong Z; Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China., Xie Q; Department of Infectious Disease, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China., Liu Z; Infectious Disease Section, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China., Li L; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China., Yu Y; Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China., Gao H; Department of Infectious Diseases, Shulan Hangzhou Hospital, Hangzhou, China., Kanj SS; Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon., Figueroa J; Department of Infectious Diseases, Hospital Universitario Erasmo Meoz ESE, Cúcuta, Colombia., Herc E; Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA., Cordova E; Infectious Diseases Unit, Hospital Cosme Argerich de Buenos Aires, Buenos Aires, Argentina., Weston G; Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Ananth Tambyah P; Infectious Diseases Translational Research Programme, National University of Singapore, Singapore., Garcia-Diaz J; Division of Infectious Diseases, Ochsner Medical Center, New Orleans, LA, USA., Kaye KS; Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA.; Division of Allergy, Immunology and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Dhar S; Division of Infectious Disease, School of Medicine, Wayne State University, Detroit, MI, USA., Munita JM; Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile., Salata RA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA., Vilchez S; Center for Infectious Disease Research, Department of Microbiology and Parasitology, School of Medicine, National Autonomous University of Nicaragua, Leon, Nicaragua., Stryjewski ME; Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina., Villegas Botero MV; Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia., Iovleva A; Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Evans S; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China.; Department of Biostatics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA., Baum K; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Hill C; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Kreiswirth BN; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA., Patel R; Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA., Paterson DL; Department of Infectious Diseases, University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia., Arias CA; Division of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX, USA.; Center for Infectious Diseases Research, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX, USA., Bonomo RA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Case Western Reserve University VA Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.; Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, OH, USA., Chambers HF; Department of Medicine, University of California San Francisco, San Francisco, CA, USA., Fowler VG; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Satlin MJ; Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA., van Duin D; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA., Doi Y; Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.; Department of Microbiology and Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Sep 20. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.1093/cid/ciad556
Abstrakt:	Background: Carbapenem-resistant Acinetobacter baumannii (CRAb) is one 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. While CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinicaltrials.gov: #NCT03646227. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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