Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant <i>Acinetobacter Baumannii</i> Among Patients From Different Global Regions
Journal
Clinical Infectious Diseases
ISSN
1058-4838
1537-6591
Date Issued
2023
Author(s)
Minggui Wang
Lizhao Ge
Liang Chen
Lauren Komarow
Blake Hanson
Jinnethe Reyes
Eric Cober
Thamer Alenazi
Zhiyong Zong
Qing Xie
Zhengyin Liu
Lanjuan Li
Yunsong Yu
Hainv Gao
Souha S Kanj
Jairo Figueroa
Erica Herc
Ezequiel Cordova
Gregory Weston
Paul Ananth Tambyah
Julia Garcia-Diaz
Keith S Kaye
Sorabh Dhar
Robert A Salata
Samuel Vilchez
Martin E Stryjewski
Maria Virginia Villegas Botero
Alina Iovleva
Scott R Evans
Keri Baum
Carol Hill
Barry N Kreiswirth
Robin Patel
David L Paterson
Cesar A Arias
Robert A Bonomo
Henry F Chambers
Vance G Fowler
Michael J Satlin
David van Duin
Yohei Doi
Souha S Kanj
Fujie Zhang
Judith J Lok
Robert A Salata
Martin Stryjewski
Valentina Di Castelnuovo
Jose Millan Oñate Gutierrez
Eric Cober
Susan Richter
Deverick J Anderson
Beth Evans
Carol Hill
Heather R Cross
Keri Baum
Rebekka Arias
Vance G Fowler
Karen Ordoñez
Jesse T Jaco
Linghua L
Barry N Kreiswirth
Claudia Manca
Liang Chen
Samit Desai
Ezequiel Cordov
Maria Riosec
Samuel Vilche
Marisa L Sanche
Sandra Valderram
Jairo Figuero
Cesar A Arias
An Q Dinh
Diane Panesso
Kirsten Rydell
Truc T Tra
Fupin Hu
Jiachun Su
Jianping Jiang
Minggui Wang
Xiaogang Xu
Yang Yan
Maria Spence
Thamer Alenazi
Robert A Bonomo
Steven H Marshall
Susan D Rudin
Charles Huskins
Kerry Greenwood-Quaintance
Robin Patel
Suzannah Schmidt-Malan
Sara Revolinski
Glenn Wortmann
Robert C Kalayjian
Gregory Weston
Belinda Ostrowsky
Gopi Patel
Daniel Eiras
Angela Kim
Julia Garcia-Diaz
Soraya Salcedo
John J Farrell
Zhengyin Liu
Andrew Henderson
David L Paterso
Qing Xie
Keith S Kaye
Hainv Gao
Yunsong Y
Mary Water
Bettina C Fries
Brandon Eilertson
Kalisvar Marimuthu
Oon Tek Ng
Partha Pratim De
Kean Lee Chew
Nares Smitasin
Paul Ananth Tambyah
Jason C Gallagher
Anton Peleg
Marcel Leroi
Lanjuan Li
Yonghong Xiao
Lauren Komarow
Lizhao Ge
Scott Evans
Todd McCarty
Henry F Chambers
Omai B Garner
Lilian M Abbo
David van Duin
Ebbing Lautenbach
Jennifer H Han
Yohei Doi
Darren Wong
Blake Hanson
Jinnethe Reyes
Maria Virginia Villegas Botero
Lorena Dia
Federico Perez
Ritu Banerjee
Sorabh Dhar
Michael J Satlin
Lars F Westblade
Zhiyong Zong
Type
Resource Types::text::journal::journal article
DOI
URL
Abstract
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality.</jats:p> <jats:p>Clinical Trials Registration. NCT03646227.</jats:p> </jats:sec>