Prognostic risk factors associated with bloodstream infections caused by <i>Acinetobacter baumannii</i>_West China Medical Journal

Authors：

LIANG Liang ¹ ,  LIU Xiaochun ¹ , CHEN Xingchun ¹ , ZHAO Li ¹ , PANG Guangbao ² , HE Yi ³ , TANG Juan ³ , ZHOU Xiangyang ³

1. Department of Clinical Laboratory, Guangxi Zhuang Autonomous Region People’s Hospital, Nanning, Guangxi 530021, P. R. China;
2. Intensive Care Unit, Guangxi Zhuang Autonomous Region People’s Hospital, Nanning, Guangxi 530021, P. R. China;
3. Guangxi Center for Clinical Laboratory, Nanning, Guangxi 530021, P. R. China;

Corresponding?author：

LIU Xiaochun, Email: tonyliu75@126.com

Keywords：

Acinetobacter baumannii; Bloodstream infection; Multidrug resistance; Risk factor; Prognosis

DOI：

10.7507/1002-0179.201911221

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Objective To explore the prognostic risk factors of bloodstream infections caused by Acinetobacter baumannii in the hospital, to provide a basis for clinical diagnosis and treatment.Methods A retrospective analysis was performed on the medical records of patients diagnosed with Acinetobacter baumannii bloodstream infection in Guangxi Zhuang Autonomous Region People’s Hospital between January 2013 and December 2018. The patients were divided into survival group and non-survival group according to the outcome within 30 days after blood culture was collected. Univariate and multivariate logistic analyses were used to identify the risk factors of Acinetobacter baumannii bloodstream infections.Results A total of 123 patients were included, including 48 in the survival group and 75 in the non-survival group. Third generation cephalosporins [odds ratio (OR)=2.492, 95% confidence interval (CI) (2.125, 2.924), P<0.001], carbapenems [OR=1.721, 95%CI (1.505, 1.969), P<0.001], multidrug resistant-Acinetobacter baumannii infection [OR=1.240, 95%CI (1.063, 1.446), P=0.006], post-operation [OR=0.515, 95%CI (0.449, 0.590), P<0.001], mechanical ventilation [OR=1.182, 95%CI (1.005, 1.388), P=0.043], indwelling central venous catheter [OR=0.116, 95%CI (0.080, 0.169), P<0.001], mixed infection or septic shock [OR=3.935, 95%CI (2.740, 5.650), P<0.001], APACHE Ⅱ score (≥15) [OR=5.939, 95%CI (5.029, 7.013), P<0.001], chronic kidney disease [OR=1.440, 95%CI (1.247, 1.662), P<0.001], immune system disease [OR=28.620, 95%CI (17.087, 47.937), P<0.001], use of corticosteroids [OR=0.520, 95%CI (0.427, 0.635), P<0.001], and combined antifungal agents [OR=0.814, 95%CI (0.668, 0.992), P=0.041] were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii.Conclusions The third generation cephalosporins, carbapenem, MDR-Acinetobacter baumannii infection, post-operation, mechanical ventilation, indwelling central venous catheter, mixed infection or septic shock, APACHE Ⅱ score (≥15), chronic kidney disease, immune system disease, use of corticosteroids, and combined antifungal agents were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii. In the clinical work, it is needed to carry out timely detection of microbial etiology, timely report, and reasonable treatment.

Citation： LIANG Liang, LIU Xiaochun, CHEN Xingchun, ZHAO Li, PANG Guangbao, HE Yi, TANG Juan, ZHOU Xiangyang. Prognostic risk factors associated with bloodstream infections caused by Acinetobacter baumannii. West China Medical Journal, 2021, 36(1): 76-81. doi: 10.7507/1002-0179.201911221 Copy

1.	Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs: no ESKAPE! An update from the infectious diseases society of America. Clin Infect Dis, 2009, 48(1): 1-12.
2.	王成軍, 許勇, 王林海, 等. 鮑氏不動桿菌感染的臨床分布特征及耐藥性分析. 中華醫院感染學雜志, 2014, 24(17): 4179-4181.
3.	胡付品, 郭燕, 朱德妹, 等. 2016 年中國 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2017, 17(5): 481-491.
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5.	Liu CP, Shih SC, Wang NY, et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2016, 49(6): 934-940.
6.	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.
7.	Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
8.	王盛標, 李濤, 李云峰, 等. 4 種評分系統對膿毒癥患者預后的評估價值: 附 311 例回顧性分析. 中華危重病急救醫學, 2017, 29(2): 133-138.
9.	中華人民共和國國家衛生健康委員會. 國家衛生計生委辦公廳關于印發麻醉等6個專業質控指標(2015年版)的通知. (2015-04-10)[2019-11-20]. http://www.nhc.gov.cn/wjw/pyzl/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
10.	Thom KA, Johnson JK, Lee MS, et al. Environmental contamination because of multidrug-resistant Acinetobacter baumannii surrounding colonized or infected patients. Am J Infect Control, 2011, 39(9): 711-715.
11.	Ryu SY, Baek WK, Kim HA. Association of biofilm production with colonization among clinical isolates of Acinetobacter baumannii. Korean J Intern Med, 2017, 32(2): 345-351.
12.	Ketter PM, Yu JJ, Guentzel MN, et al. Acinetobacter baumannii gastrointestinal colonization is facilitated by secretory IgA which is reductively dissociated by bacterial thioredoxin A. MBio, 2018, 9(4): e01298-18.
13.	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.
14.	Pu L, Jian Z, Pan F, et al. Comparative genomic analysis and multi-drug resistance differences of Acinetobacter baumannii in Chongqing, China. Infect Drug Resist, 2019, 12: 2827-2838.
15.	Zhang X, Gu B, Mei Y, et al. Increasing resistance rate to carbapenem among blood culture isolates of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa in a university-affiliated hospital in China, 2004-2011. J Antibiot (Tokyo), 2015, 68(2): 115-120.
16.	韓靜靜, 鄧艷萍, 高鑫, 等. ICU 中革蘭陰性菌血流感染的危險因素分析. 重慶醫學, 2016, 45(12): 1638-1640, 1644.
17.	Guo N, Xue W, Tang D, et al. Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China. Am J Infect Control, 2016, 44(4): e37-e39.
18.	張青, 王小亭, 張宏民, 等. 重癥臨床急性生理學及慢性健康狀況系統評分與人工評分的比較. 中華醫學雜志, 2015, 95(39): 3173-3175.

1. Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs: no ESKAPE! An update from the infectious diseases society of America. Clin Infect Dis, 2009, 48(1): 1-12.
2. 王成軍, 許勇, 王林海, 等. 鮑氏不動桿菌感染的臨床分布特征及耐藥性分析. 中華醫院感染學雜志, 2014, 24(17): 4179-4181.
3. 胡付品, 郭燕, 朱德妹, 等. 2016 年中國 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2017, 17(5): 481-491.
4. Kasper DL, Fauci AS. 哈里森感染病學. 3 版. 胡必杰, 潘玨, 高曉東, 譯. 上海: 上海科學技術出版社, 2019: 469.
5. Liu CP, Shih SC, Wang NY, et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect, 2016, 49(6): 934-940.
6. 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.
7. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 2012, 18(3): 268-281.
8. 王盛標, 李濤, 李云峰, 等. 4 種評分系統對膿毒癥患者預后的評估價值: 附 311 例回顧性分析. 中華危重病急救醫學, 2017, 29(2): 133-138.
9. 中華人民共和國國家衛生健康委員會. 國家衛生計生委辦公廳關于印發麻醉等6個專業質控指標(2015年版)的通知. (2015-04-10)[2019-11-20]. http://www.nhc.gov.cn/wjw/pyzl/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
10. Thom KA, Johnson JK, Lee MS, et al. Environmental contamination because of multidrug-resistant Acinetobacter baumannii surrounding colonized or infected patients. Am J Infect Control, 2011, 39(9): 711-715.
11. Ryu SY, Baek WK, Kim HA. Association of biofilm production with colonization among clinical isolates of Acinetobacter baumannii. Korean J Intern Med, 2017, 32(2): 345-351.
12. Ketter PM, Yu JJ, Guentzel MN, et al. Acinetobacter baumannii gastrointestinal colonization is facilitated by secretory IgA which is reductively dissociated by bacterial thioredoxin A. MBio, 2018, 9(4): e01298-18.
13. 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.
14. Pu L, Jian Z, Pan F, et al. Comparative genomic analysis and multi-drug resistance differences of Acinetobacter baumannii in Chongqing, China. Infect Drug Resist, 2019, 12: 2827-2838.
15. Zhang X, Gu B, Mei Y, et al. Increasing resistance rate to carbapenem among blood culture isolates of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa in a university-affiliated hospital in China, 2004-2011. J Antibiot (Tokyo), 2015, 68(2): 115-120.
16. 韓靜靜, 鄧艷萍, 高鑫, 等. ICU 中革蘭陰性菌血流感染的危險因素分析. 重慶醫學, 2016, 45(12): 1638-1640, 1644.
17. Guo N, Xue W, Tang D, et al. Risk factors and outcomes of hospitalized patients with blood infections caused by multidrug-resistant Acinetobacter baumannii complex in a hospital of Northern China. Am J Infect Control, 2016, 44(4): e37-e39.
18. 張青, 王小亭, 張宏民, 等. 重癥臨床急性生理學及慢性健康狀況系統評分與人工評分的比較. 中華醫學雜志, 2015, 95(39): 3173-3175.

West China Medical Journal

Prognostic risk factors associated with bloodstream infections caused by Acinetobacter baumannii

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