Abstract
This study aimed to explore the activity of combined antimicrobials in vitro, and the relationship among resistance mechanisms, antimicrobial regimens, and the clinical outcome of patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infections in western China. A total of 89 CRAB strains were collected from patients with CRAB infection from January 2018 to June 2018. The checkerboard assay was used to study the combined effects in vitro. Carbapenemase-encoding genes were detected by polymerase chain reaction (PCR) or multiplex PCR technique. The clinical data of 86 patients were collected. CRAB showed high susceptibility to tigecycline (91.01% inhibition) and polymyxin (83.15% inhibition). Polymyxin plus sulbactam exhibited the highest synergistic effect at a rate of 82.35%. Production of carbapenemase (blaOXA–23) was the main resistance mechanism of CRAB to carbapenem (95.35%). Excessive expression of active efflux pump genes (adeB, adeJ, and abeM) and deletion of the CarO protein accounted for 13.95% (12/86) and 84.88% (73/86), respectively. The synergistic effect of the sulbactam-based combination was higher than that of the polymyxin B-tigecycline combination for carbapenemase-producing CRAB (P < 0.05). The clinical outcome was not affected by the resistance mechanisms (P > 0.05). Advanced age, multiple organ dysfunction syndromes (MODS), and admission to the intensive care unit (ICU) were associated with treatment failure (P < 0.05). Appropriate antibiotic therapy did not improve the clinical outcome of critically ill patients. Higher minimum inhibitory concentrations (MICs) of tigecycline were associated with treatment failure (P < 0.05). A multivariate analysis showed that ICU stay (OR = 15.123, 95% CI: 2.600–87.951, P = 0.002) and procalcitonin ≥2 ng/ml (OR = 2.636, 95% CI: 1.173–5.924, P = 0.019) were the risk factors for treatment failure. In conclusion, this study demonstrated that the sulbactam-based combination exhibited a synergistic effect in vitro. The clinical outcome of patients was not associated with resistance mechanisms. This indicates that the early control of the progression from infection to severe disease may be important.
Highlights
Carbapenem-resistant Acinetobacter baumannii (CRAB) is at the top of the World Health Organization’s list of drugresistant bacteria and poses a significant threat to human health (Willyard, 2017)
(2) It investigated the mechanisms of carbapenem resistance in clinical carbapenem-resistant Acinetobacter baumannii (CRAB) strains. (3) we evaluated the relationship between resistance mechanisms, antimicrobial regimens, and clinical outcomes in patients with CRAB infections
The patients at an advanced age, those with multiple organ dysfunction syndromes (MODS), those with a lower level of estimated glomerular filtration rate (eGFR), and those admitted to the intensive care unit (ICU) had a poor clinical outcome, which was similar to that in previous studies (Sheng et al, 2010; Niu et al, 2018; Du et al, 2019)
Summary
Carbapenem-resistant Acinetobacter baumannii (CRAB) is at the top of the World Health Organization’s list of drugresistant bacteria and poses a significant threat to human health (Willyard, 2017). It can cause severe infections including pneumonia, bloodstream infection, abdominal infection, and skin and soft tissue infection, for which almost no treatment is available (Willyard, 2017). The treatment options for CRAB infections are limited, including colistin, tigecycline, sulbactam, and aminoglycosides (Karaiskos et al, 2017). There are no convincing studies that recommend the combination of carbapenems, colistin, or sulbactam (Karaiskos et al, 2017)
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