Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients From Different Global Regions.
Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant Acinetobacter baumannii Among Patients From Different Global Regions.
复制标题
全球不同地区患者中耐碳青霉烯鲍曼不动杆菌的临床结果和细菌特征。
DOI：
10.1093/cid/ciad556
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Cordova,Eze
中科院分区：
文献类型：
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作者：
Wang,Minggui;Ge,Lizhao;Chen,Liang;Komarow,Lauren;Hanson,Blake;Reyes,Jinnethe;Cober,Eric;Alenazi,Thamer;Zong,Zhiyong;Xie,Qing;Liu,Zhengyin;Li,Lanjuan;Yu,Yunsong;Gao,Hainv;Kanj,SouhaS;Figueroa,Jairo;Herc,Erica;Cordova,Eze
背景耐碳青霉烯类鲍曼不动杆菌（Acinetobacter baumannii，CRAb）是目前最具争议的耐药菌之一。我们试图阐明CRAb.MethodsIn一项前瞻性观察性队列研究的国际流行病学和临床影响，842名住院患者与临床CRAb文化在2017年至2019年期间在全球五个地区的46家医院入组。主要结局是从索引培养开始30天时的全因死亡率。菌株进行全基因组analysis.ResultsOf 842例，536（64%）代表感染。到30天，128名（24%）感染患者死亡，从澳大利亚-新加坡的18人中的1人（6%）到美国的216人中的54人（25%）和中南美洲的49人中的24人（49%），而42名（14%）未感染患者死亡。与其他类型的感染相比，菌血症与更高的死亡风险相关（40/96 [42%] vs 88/440 [20%]）。在多变量logistic回归分析中，血流感染和较高的年龄校正Charlson合并症指数与30天死亡率独立相关。除中南美洲外，克隆组2（CG 2）菌株占主导地位，范围从美国的369株中的216株（59%）到中国的291株中的282株（97%）。获得性碳青霉烯酶基因携带769（91%）的842株。CG 2菌株与美罗培南耐药水平较高显着相关，但非CG 2的情况下，死亡人数过多的CG 2 cases.ConclusionsCRAb感染类型和临床结果显着不同地区。虽然CG 2菌株仍然占主导地位，但非CG 2菌株与较高的死亡率相关。
BackgroundCarbapenem-resistantAcinetobacter baumannii(CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.MethodsIn 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.ResultsOf 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.ConclusionsCRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality.Clinical Trials Registration.NCT03646227.