Extensively drug-resistant Acinetobacter baumannii bacteraemia in a multidisciplinary intensive care unit during a
M Katsiari1, A Mavroidi2, E D Platsouka2
1Intensive Care Unit, Konstantopouleio-Patission General Hospital, 3-5 Agias Olgas Street, 142 33 N. Ionia, Athens, Greece.
Objectives:
This study aimed to determine potential host-, pathogen-, infection- and treatment-related risk factors that might predict a fulminant fatal course of bacteraemia caused by extensively drug-resistant Acinetobacter baumannii (XDR-Aba).
Methods:
Eighty-seven patients with monomicrobial growth of XDR-Aba in blood cultures within a 6-year period (2011-2016) were studied. Patients were divided into three groups according to ICU outcome: Group A (n=40) consisted of patients who survived; Group B (n=10) included patients with fulminant sepsis who died early (≤48h); and Group C (n=37) included patients who died later (>48h) after the onset of bacteraemia.
Results:
Regarding patient co-morbidities, patients who died from fulminant XDR-Aba bacteraemia had a significantly higher prevalence of chronic renal failure compared with patients who survived (40.0% vs. 7.5%; P=0.029). Patients with fulminant sepsis showed more severe organ dysfunction based on SOFA score compared with survivors (10.83±2.93 vs. 6.65±3.6; P=0.013). The primary to secondary bacteraemia ratio and appropriate treatment were similar among the three outcome groups. Patients with fulminant bacteraemia displayed higher rates of colistin-, tigecycline- and pandrug-resistant strains, although not statistically significant.
Conclusions:
Patients suffering from a fulminant course of XDR-Aba bacteraemia showed significantly higher rates of chronic renal failure and multiple organ dysfunction. Resistance patterns of XDR-Aba isolates and receipt of appropriate treatment did not affect outcomes. Further studies including larger samples of patients along with investigation of specific virulence determinants of individual Aba strains are needed.
Insights
Fulminant sepsis from extensively drug-resistant Acinetobacter baumannii (XDR-Aba) is linked to chronic renal failure and organ dysfunction. Treatment and resistance patterns did not significantly impact outcomes in this study.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Resistance
Background:
- Extensively drug-resistant Acinetobacter baumannii (XDR-Aba) poses a significant threat in healthcare settings.
- Fulminant sepsis from XDR-Aba can lead to rapid deterioration and death.
- Identifying risk factors for fatal outcomes is crucial for improving patient management.
Purpose of the Study:
- To identify host, pathogen, infection, and treatment-related risk factors predicting a fulminant fatal course of XDR-Aba bacteraemia.
- To compare clinical characteristics and outcomes among survivors, early non-survivors (fulminant sepsis), and late non-survivors.
Main Methods:
- Retrospective study of 87 patients with monomicrobial XDR-Aba bacteraemia from 2011-2016.
- Patients categorized into three groups based on ICU outcome: survival, early death (≤48h), and late death (>48h).
- Analysis of patient comorbidities, Sequential Organ Failure Assessment (SOFA) scores, bacteraemia source, treatment, and isolate resistance patterns.
Main Results:
- Patients with fulminant XDR-Aba sepsis had significantly higher rates of chronic renal failure (40.0% vs. 7.5%) and greater organ dysfunction (SOFA score 10.83±2.93 vs. 6.65±3.6) compared to survivors.
- No significant differences were observed in bacteraemia source, appropriate treatment, or resistance patterns (colistin, tigecycline, pandrug resistance) between outcome groups.
- Higher rates of pandrug-resistant strains were noted in fulminant cases, though not statistically significant.
Conclusions:
- Chronic renal failure and multiple organ dysfunction are significant predictors of a fulminant fatal course in XDR-Aba bacteraemia.
- Antimicrobial resistance patterns and receipt of appropriate treatment did not appear to influence patient outcomes in this cohort.
- Further research with larger patient cohorts and investigation of specific bacterial virulence factors is warranted.
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