AI Article Synopsis

  • Carbapenem-resistant Acinetobacter baumannii (CRAb) is a major concern in antimicrobial resistance, with a study conducted on 842 hospitalized patients from 46 hospitals across five regions to assess its clinical impact and epidemiology between 2017 and 2019.
  • The study found that 64% of the cases were infections, with a 30-day mortality rate of 24% among infected patients, highlighting notable regional differences in mortality rates.
  • Additionally, both bloodstream infections and higher comorbidity were linked to increased mortality, while the dominant clonal group (CG2) was prevalent but non-CG2 strains resulted in higher death rates despite lower resistance to treatment.

Article Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb.

Methods: In 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.

Results: Of 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.

Conclusions: CRAb 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874260PMC
http://dx.doi.org/10.1093/cid/ciad556DOI Listing

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