Abstract
The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.
Highlights
Acinetobacter baumannii (AB) is an opportunistic gram-negative with a tendency to colonize the hospital environment: bed rails, floors, ventilator pads, supply carts and infusion pumps in the Intensive Care Unit (ICU) [1,2]
In 28/39 (71,8%) it occurred during ICU hospitalization, while in the other 11/39 (28.2%) patients, AB sepsis itself was the cause of ICU admission
Our study showed that septic patients with bloodstream infection (BSI) from XDR ABCoR have a significantly higher mortality when compared to septic patients with XDR ABCoR BSIs with the colistin-sensitive (ABCoS) BSIs
Summary
Acinetobacter baumannii (AB) is an opportunistic gram-negative with a tendency to colonize the hospital environment: bed rails, floors, ventilator pads, supply carts and infusion pumps in the Intensive Care Unit (ICU) [1,2]. It has the remarkable capacities to survive in dry conditions for a long period of time, to be resistant to disinfectants and form biofilm on abiotic surfaces [3], and to develop resistance to antibiotics. It predominantly infects critically ill hospitalized patients and it is a frequent cause of nosocomial infections, mainly ventilator-associated pneumonia and bloodstream infection [4]. XDR AB has been reported worldwide as a major cause of healthcare-associated infections and nosocomial outbreaks [17], and is recognized as one of the most difficult hospital pathogens to be treated and controlled and is considered a global threat in the health-care setting [18]
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