Multidrug-Resistant Acinetobacter baumannii May Cause Patients to Develop Polymicrobial Bloodstream Infection
Qingqing Chen1, Zhencang Zheng2, Qingxin Shi3
1Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 318000, China.
Background:
The incidence of polymicrobial bloodstream infections is increasing, the clinical characteristics of polymicrobial Acinetobacter baumannii bloodstream infections (AB-BSI) are unclear, and there are no reports of polymicrobial AB-BSI in mainland China. Therefore, our objective was to identify the clinical characteristics, risk factors, and outcomes of polymicrobial AB-BSI versus monomicrobial AB-BSI.
Methods:
A retrospective survey of all patients with AB-BSI from January 1, 2015, to December 31, 2019, and their clinical data were collected and analyzed by reviewing electronic medical records. All data were compared and analyzed between groups of monomicrobial and polymicrobial AB-BSI. Risk factors for polymicrobial AB-BSI were assessed using multivariable logistic regression analysis.
Results:
A total of 204 patients were included, of which 39 (19.1%) were patients with polymicrobial AB-BSI. The main sources of the pathogenicity of polymicrobial Acinetobacter baumannii bloodstream infections were skin and soft tissue (38.5% vs. 16.4%, p=0.002). Resistance to piperacillin/tazobactam as an independent factor for polymicrobial AB-BSI was found in multivariate analysis. Patients with polymicrobial AB-BSI had longer hospital stays compared to those with monomicrobial AB-BSI. However, there was no significant difference in mortality between the two groups.
Conclusions:
Polymicrobial AB-BSI accounted for a significant proportion among all AB-BSI, and it did not influence mortality but was related to slightly longer total hospital stays. Multidrug resistance was associated with the development of polymicrobial AB-BSI but does not directly lead to polymicrobial AB-BSI, whereas resistance to piperacillin/tazobactam was highly correlated with polymicrobial AB-BSI. Therefore, while treating A. baumannii bloodstream infections, clinicians cannot ignore the multidrug-resistant A. baumannii, especially piperacillin/tazobactam-resistant A. baumannii, which may predispose to the development of polymicrobial AB-BSI.
Insights
Polymicrobial Acinetobacter baumannii bloodstream infections (AB-BSI) are increasingly reported. Resistance to piperacillin/tazobactam is a key risk factor, though polymicrobial AB-BSI does not increase mortality but may prolong hospital stays.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Polymicrobial bloodstream infections (BSI) are rising globally.
- Clinical features of polymicrobial Acinetobacter baumannii BSI (AB-BSI) remain poorly understood.
- No prior reports of polymicrobial AB-BSI exist in mainland China.
Purpose of the Study:
- To investigate the clinical characteristics of polymicrobial AB-BSI.
- To identify risk factors associated with polymicrobial AB-BSI.
- To compare outcomes between polymicrobial and monomicrobial AB-BSI.
Main Methods:
- Retrospective analysis of 204 patients with AB-BSI from 2015-2019.
- Electronic medical records were reviewed for clinical data.
- Multivariable logistic regression identified risk factors for polymicrobial AB-BSI.
Main Results:
- Polymicrobial AB-BSI occurred in 19.1% of patients.
- Skin and soft tissue infections were more common sources in polymicrobial cases (38.5% vs 16.4%).
- Piperacillin/tazobactam resistance was an independent risk factor; longer hospital stays were observed in polymicrobial cases, with no significant mortality difference.
Conclusions:
- Polymicrobial AB-BSI represents a significant proportion of AB-BSI cases.
- While not impacting mortality, polymicrobial AB-BSI is linked to extended hospital stays.
- Piperacillin/tazobactam resistance is highly correlated with polymicrobial AB-BSI, necessitating attention during treatment.
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