Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study - 18/07/19

Doi : 10.1016/j.jinf.2019.05.017

Alessandro Russo ^a, Matteo Bassetti ^a, Giancarlo Ceccarelli ^b, Novella Carannante ^c, Angela Raffaella Losito ^d, Michele Bartoletti ^e, Silvia Corcione ^f, Guido Granata ^g, Antonella Santoro ^h, Daniele Roberto Giacobbe ^i,^j, Maddalena Peghin ^a, Antonio Vena ^a, Francesco Amadori ^k, Francesco Vladimiro Segala ^f, Maddalena Giannella ^e, Giovanni Di Caprio ^c, Francesco Menichetti ^k, Valerio Del Bono ^l, Cristina Mussini ^h, Nicola Petrosillo ^g, Francesco Giuseppe De Rosa ^f, Pierluigi Viale ^e, Mario Tumbarello ^d, Carlo Tascini ^c, Claudio Viscoli ^i,^j, Mario Venditti ^b,^⁎
ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)
^a Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
^b Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università 37, 00161 Rome, Italy
^c First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
^d Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
^e Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
^f Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
^g Clinical and Research Department for Infectious Diseases, Unit Systemic and Immunedepression-Associated Infections, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
^h Clinic of Infectious Disease, University Hospital, Modena, Italy
ⁱ Infectious Diseases Unit, Ospedale Policlinico San Martino – IRCCS per l'Oncologia, Italy
^j Department of Health Sciences, University of Genoa, Genoa, Italy
^k Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
^l Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy

^⁎Corresponding author.: Prof. Mario Venditti, Department of Public Health and Infectious Diseases, Policlinico Umberto I, Viale dell'Università 37, 00161 “Sapienza” University of Rome (Italy)

Highlights

•	MDR Acinetobacter baumannii infections represents a challenge for physicians.
•	Bloodstream infections are related to high rates of septic shock and mortality.
•	Data highlight a predominant role for colistin in definitive antibiotic regimens.
•	Lack of scientific data might explain the very high mortality rate observed.
•	This real-life clinical experience provides useful suggestions on this difficult-to-treat infection.

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Summary

Objectives

bloodstream infections (BSI) due to multidrug-resistant (MDR) Acinetobacter baumannii (AB) have been increasingly observed among hospitalized patients.

Methods

prospective, observational study conducted among 12 large tertiary-care hospitals, across 7 Italian regions. From June 2017 to June 2018 all consecutive hospitalized patients with bacteremia due to MDR-AB were included and analyzed in the study.

Results

During the study period 281 episodes of BSI due to MDR-AB were observed: 98 (34.8%) episodes were classified as primary bacteremias, and 183 (65.2%) as secondary bacteremias; 177 (62.9%) of them were associated with septic shock. Overall, 14-day mortality was observed in 172 (61.2%) patients, while 30-day mortality in 207 (73.6%) patients. On multivariate analysis, previous surgery, continuous renal replacement therapy, inadequate source control of infection, and pneumonia were independently associated with higher risk of septic shock. Instead, septic shock and Charlson Comorbidity Index >3 were associated with 14-day mortality, while adequate source control of infection and combination therapy with survival. Finally, septic shock, previous surgery, and aminoglycoside-containing regimen were associated with 30-day mortality, while colistin-containing regimen with survival.

Conclusions

BSI caused by MDR-AB represents a difficult challenge for physicians, considering the high rates of septic shock and mortality associated with this infection.

Le texte complet de cet article est disponible en PDF.

Keywords : Bacteremia, Septic shock, Acinetobacter, Multidrug-resistant, Colistin

Plan

Introduction

Patients and method

Study design and patient selection

Definitions and MDR-AB identification

Antimicrobial treatment evaluation and adequate source control of infection

Primary endpoint and statistical analysis

Results

Discussion

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Vol 79 - N° 2

P. 130-138 - août 2019 Retour au numéro

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Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study - 18/07/19

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