Risk factors for colistin-resistant, extensively drug-resistant (XDR) and pandrug-resistant (PDR) Acinetobacter
Christos Vrysis1, Dimitrios S Kontogiannis1, Dimitrios Ntourakis2
1Alfa Institute of Biomedical Sciences, Athens, Greece.
Introduction:
Acinetobacter baumannii clinical isolates commonly have high antimicrobial resistance levels. We evaluated the risk factors associated with colistin-resistant, extensively drug-resistant (XDR), and pan-drug-resistant (PDR) Acinetobacter baumannii.
Areas Covered:
A literature review was done using three electronic resources, encompassing 18 observational studies with 2,462 participants. Our study examined the association between risk factors and infections caused by colistin-resistant (6 studies, 847 participants), XDR (10 studies, 1413 participants), and PDR Acinetobacter baumannii (3 studies, 202 participants). The most common independent risk factor identified for all three resistance phenotypes was prior use of antibiotics, with adjusted odds ratios (aORs) ranging from 1.3 to 155.9. Additional contributing factors included mechanical ventilation, prolonged stays in the intensive care unit (ICU), and use of invasive devices, such as urinary catheters, central line catheters, and hemodialysis catheters. The severity of illness was also linked to these infections, as indicated by high scores on the APACHE II, SOFA, or SAPS II scales.
Expert Opinion:
Certain risk factors, particularly prior use of antibiotics, have been consistently associated with the development of three resistant phenotypes. Future research should focus on multicenter studies with well-defined criteria for resistance, identifying risk factors, and guiding intervention strategies more effectively.
Insights
Prior antibiotic use is a key risk factor for resistant Acinetobacter baumannii infections. Mechanical ventilation, ICU stays, and invasive devices also contribute to colistin-resistant, extensively drug-resistant (XDR), and pan-drug-resistant (PDR) infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Acinetobacter baumannii clinical isolates frequently exhibit high antimicrobial resistance.
- The emergence of colistin-resistant, extensively drug-resistant (XDR), and pan-drug-resistant (PDR) strains poses a significant clinical challenge.
Purpose of the Study:
- To evaluate risk factors associated with colistin-resistant, XDR, and PDR Acinetobacter baumannii infections.
- To identify independent risk factors contributing to these challenging phenotypes.
Main Methods:
- A comprehensive literature review of 18 observational studies involving 2,462 participants.
- Analysis of associations between risk factors and specific resistance phenotypes (colistin-resistant, XDR, PDR).
Main Results:
- Prior antibiotic use was the most common independent risk factor across all resistance phenotypes (aORs 1.3–155.9).
- Mechanical ventilation, prolonged ICU stays, and invasive devices (urinary catheters, central lines, hemodialysis catheters) were significant contributing factors.
- Higher severity of illness scores (APACHE II, SOFA, SAPS II) correlated with these resistant infections.
Conclusions:
- Prior antibiotic use is a consistent risk factor for developing resistant Acinetobacter baumannii.
- Future multicenter studies are needed to refine resistance criteria and guide intervention strategies effectively.
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