Clinical analysis and trend in antimicrobial resistance of <i>Acinetobacter baumannii</i> bloodstream infection in a tertiary hospital from 2010 to 2016 _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TAN Jianlong ¹ , ZHANG Weidong ¹ , XIE Liangyi ² ,  LIU Zhiguang ¹

1. Department of Respiratory Medicine, Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P. R. China;
2. Department of Laboratory Medicine, Hunan Provincial Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P. R. China;

Corresponding?author：

LIU Zhiguang, Email: liuzhiguang0404@126.com

Keywords：

Acinetobacter baumannii; Bloodstream infection; Drug resistance; Antimicrobial agent

DOI：

10.7507/1671-6205.201710026

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Objective To review the clinical features and trend in antimicrobial resistance of Acinetobacter baumannii (A. baumannii) bloodstream infections. Methods Retrospective analysis was performed by collecting data of underlying diseases, potential risk factors, clinical characteristics, blood test results, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores at onset, bacterial resistance to antibiotics and antimicrobial therapy were collected in Hunan Provincial People’s Hospital from January 2010 to June 2016. Results There were 114 non-duplicated A. baumannii complex blood isolates identified in this research. All patients had at least one underlying disease and accepted at least one surgery or invasive operation within the past 14 days. Multidrug-resistant A. baumannii (MDRAB) was isolated from 89 (78.1%) patients. Of the 114 strains of A. baumannii, 12.3% were resistant to tigecycline, 55.3% to amikacin and 61.4% to cefoperazone-sulbactam. The overall mortality was 51.8% (59/114). The patients with MDRAB had higher mortality rate than those with non-MDRAB (62.9% vs. 12.0%, χ²=20.268, P<0.001). With higher incidence of being in the intensive care unit, intubation/tracheotomy and increased APACHEⅡ score among patients with MDRAB bacteremia (P<0.05). Compared with subjects treated with tigecycline based regimen, those treated with non tigecycline for multidrug resistantA. baumannii had a higher mortality (64.8% vs. 60.0%) but there was no statistical significance (P>0.05). Conclusions The isolated A. baumannii are mainly multidrug resistant and with high mortality. Being in the intensive care unit, increased APACHEⅡ score and intubation/tracheotomy were risk factors for higher mortality among patients with MDRAB bloodstream infection. Tigecycline based regimen doesn’t improve patients’ prognosis.

Citation： TAN Jianlong, ZHANG Weidong, XIE Liangyi, LIU Zhiguang. Clinical analysis and trend in antimicrobial resistance of Acinetobacter baumannii bloodstream infection in a tertiary hospital from 2010 to 2016 . Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(3): 237-242. doi: 10.7507/1671-6205.201710026 Copy

1.	呂媛, 李耘, 薛峰, 等. 衛生部全國細菌耐藥監測網(Mohnarin) 2011-2012 年度血流感染細菌耐藥監測報告. 中國臨床藥理學雜志, 2014, 30(3): 278-288.
2.	李軍, 劉清霞, 黃澤炳, 等. 某醫院感染病區 2011-2015 年臨床分離病原菌及其耐藥性. 中國感染控制雜志, 2016, 15(7): 471-475.
3.	何祿娟, 孟婕, 黃大毛, 等. ICU 多重耐藥鮑曼不動桿菌血流感染的回顧性分析. 中南大學學報(醫學版), 2015, 40(12): 1327-1332.
4.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
5.	陳佰義, 何禮賢, 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2): 76-85.
6.	Gulen TA, Guner R, Celikbilek N, et al. Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii. Int J Infect Dis, 2015, 38(9): 32-35.
7.	胡付品, 朱德妹, 汪復, 等. 2015年 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2016, 16(6): 685-694.
8.	張密, 陳延斌. 鮑曼不動桿菌血流感染 136 例臨床分析. 中國感染與化療雜志, 2016, 16(4): 385-388.
9.	Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric in patients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control, 2015, 43(8): 857-860.
10.	張銀維, 周華, 蔡洪流, 等. 鮑曼不動桿菌血流感染臨床特征和死亡危險因素分析. 中華內科雜志, 2016, 55(2): 121-126.
11.	廖紀萍, 孫立穎, 馬靖, 等. 泛耐藥鮑曼不動桿菌菌血癥的臨床特點及預后. 中國呼吸與危重監護雜志, 2017, 16(5): 436-440.
12.	Huang ST, Chiang MC, Kuo SC, et al. Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2012, 45(5): 356-362.
13.	隆云, 郭清華, 劉大為, 等. 泛耐藥鮑曼不動桿菌菌血癥危險因素及臨床結局. 協和醫學雜志, 2015, 6(4): 260-266.
14.	Liu Q, Li W, Du X, et al. Risk and prognostic factors for multidrug-resistant acinetobacter baumannii complex bacteremia: a retrospective study in a tertiary hospital of west China. PLoS One, 2015, 10(6): e0130701.
15.	Tsai MH, Chu SM, Hsu JF, et al. Polymicrobial bloodstream infection in neonates: microbiology, clinical characteristics, and risk factors. PLoS One, 2014, 9(1): e83082.
16.	Gu Z, Han Y, Meng T, et al. Risk factors and clinical outcomes for patients with Acinetobacter baumannii bacteremia. Medicine (Baltimore), 2016, 95(9): e2943.
17.	Chang YY, Liu YM, Liu CP, et al. Impact of reduced tigecycline susceptibility on clinical outcomes of Acinetobacter bacteremia. J Microbiol Immunol Infect, 2017. https://doi.org/10.1016/j.jmii.2017.08.024.
18.	Cheng A, Chuang YC, Sun HY, et al. Excess mortality associated with colistin-tigecycline compared with colistin-carbapenem combination therapy for extensively drug-resistant Acinetobacter baumannii bacteremia: a multicenter prospective observational study. Crit Care Med, 2015, 43(6): 1194-1204.
19.	Liou BH, Lee YT, Kuo SC, et al. Efficacy of tigecycline for secondary Acinetobacter bacteremia and factors associated with treatment failure. Antimicrob Agents Chemother, 2015, 59(6): 3637-3640.

1. 呂媛, 李耘, 薛峰, 等. 衛生部全國細菌耐藥監測網(Mohnarin) 2011-2012 年度血流感染細菌耐藥監測報告. 中國臨床藥理學雜志, 2014, 30(3): 278-288.
2. 李軍, 劉清霞, 黃澤炳, 等. 某醫院感染病區 2011-2015 年臨床分離病原菌及其耐藥性. 中國感染控制雜志, 2016, 15(7): 471-475.
3. 何祿娟, 孟婕, 黃大毛, 等. ICU 多重耐藥鮑曼不動桿菌血流感染的回顧性分析. 中南大學學報(醫學版), 2015, 40(12): 1327-1332.
4. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
5. 陳佰義, 何禮賢, 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2): 76-85.
6. Gulen TA, Guner R, Celikbilek N, et al. Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii. Int J Infect Dis, 2015, 38(9): 32-35.
7. 胡付品, 朱德妹, 汪復, 等. 2015年 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2016, 16(6): 685-694.
8. 張密, 陳延斌. 鮑曼不動桿菌血流感染 136 例臨床分析. 中國感染與化療雜志, 2016, 16(4): 385-388.
9. Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric in patients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control, 2015, 43(8): 857-860.
10. 張銀維, 周華, 蔡洪流, 等. 鮑曼不動桿菌血流感染臨床特征和死亡危險因素分析. 中華內科雜志, 2016, 55(2): 121-126.
11. 廖紀萍, 孫立穎, 馬靖, 等. 泛耐藥鮑曼不動桿菌菌血癥的臨床特點及預后. 中國呼吸與危重監護雜志, 2017, 16(5): 436-440.
12. Huang ST, Chiang MC, Kuo SC, et al. Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2012, 45(5): 356-362.
13. 隆云, 郭清華, 劉大為, 等. 泛耐藥鮑曼不動桿菌菌血癥危險因素及臨床結局. 協和醫學雜志, 2015, 6(4): 260-266.
14. Liu Q, Li W, Du X, et al. Risk and prognostic factors for multidrug-resistant acinetobacter baumannii complex bacteremia: a retrospective study in a tertiary hospital of west China. PLoS One, 2015, 10(6): e0130701.
15. Tsai MH, Chu SM, Hsu JF, et al. Polymicrobial bloodstream infection in neonates: microbiology, clinical characteristics, and risk factors. PLoS One, 2014, 9(1): e83082.
16. Gu Z, Han Y, Meng T, et al. Risk factors and clinical outcomes for patients with Acinetobacter baumannii bacteremia. Medicine (Baltimore), 2016, 95(9): e2943.
17. Chang YY, Liu YM, Liu CP, et al. Impact of reduced tigecycline susceptibility on clinical outcomes of Acinetobacter bacteremia. J Microbiol Immunol Infect, 2017. https://doi.org/10.1016/j.jmii.2017.08.024.
18. Cheng A, Chuang YC, Sun HY, et al. Excess mortality associated with colistin-tigecycline compared with colistin-carbapenem combination therapy for extensively drug-resistant Acinetobacter baumannii bacteremia: a multicenter prospective observational study. Crit Care Med, 2015, 43(6): 1194-1204.
19. Liou BH, Lee YT, Kuo SC, et al. Efficacy of tigecycline for secondary Acinetobacter bacteremia and factors associated with treatment failure. Antimicrob Agents Chemother, 2015, 59(6): 3637-3640.

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Clinical analysis and trend in antimicrobial resistance of Acinetobacter baumannii bloodstream infection in a tertiary hospital from 2010 to 2016

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