Detection characteristics and factors associated with the co-occurrence of carbapenem-resistant <i>Acinetobacter baumannii</i> and carbapenem-resistant <i>Klebsiella pneumoniae</i> in two hospitals in Sichuan Province, China in 2025_West China Medical Journal

Authors：

CHEN Shujuan ¹ , LI Yizhe ² , SHI Wu ¹ , YIN Weijia ¹ , ZHU Shichao ¹ , QIAO Fu ¹ ,  ZONG Zhiyong ³

1. Department of Hospital Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Hospital Infection Control, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan 610213, P. R. China;
3. Centre for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZONG Zhiyong, Email: zongzhiy@scu.edu.cn

Keywords：

Carbapenem-resistant Acinetobacter baumannii; carbapenem-resistant Klebsiella pneumoniae; co-occurrence; epidemiology

DOI：

10.7507/1002-0179.202602220

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To establish a novel stratified framework for classifying the co-occurrence of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP), and to characterize its frequency, distribution, and associated factors. Methods A retrospective study was conducted among patients with microbiological results positive for CRAB and/or CRKP at West China Hospital, Sichuan University, and West China Tianfu Hospital, Sichuan University in 2025. Based on the interval between specimen collection dates, CRAB-CRKP co-occurrence was classified as confirmed co-occurrence (same day), probable co-occurrence (≤2 days), or possible co-occurrence (>2 days). Co-occurrence sites were also categorized. Descriptive analyses were performed to characterize CRAB and CRKP detection, and multivariable logistic regression was used to identify factors associated with CRAB-CRKP co-occurrence. Results A total of 2421 patients were included, of whom 347 (14.3%) had CRAB-CRKP co-occurrence, including 237 (9.8%) with confirmed co-occurrence, 14 (0.6%) with probable co-occurrence, and 96 (4.0%) with possible co-occurrence. Among the 347 patients with co-occurrence, 274 (79.0%) had CRAB and CRKP detected at the same anatomical site. A total of 694 relevant specimens were included, of which 571 (82.3%) were respiratory specimens. Multivariable logistic regression showed that trauma was independently associated with CRAB-CRKP co-occurrence [odds ratio (OR)=2.01, 95% confidence interval (CI) (1.09, 3.70), P=0.025]; compared with the combined group of other departments, admission to the Neurology Center [OR=3.28, 95%CI (1.88, 5.73)], Department of Respiratory and Critical Care Medicine [OR=2.76, 95%CI (1.77, 4.31)], Trauma Center [OR=2.47, 95%CI (1.37, 4.45)], Department of Intensive Care Medicine [OR=2.32, 95%CI (1.56, 3.43)], and Emergency Department [OR=1.96, 95%CI (1.35, 2.86)] was significantly associated with CRAB-CRKP co-occurrence (P<0.05). Conclusions CRAB-CRKP co-occurrence was relatively common among patients with CRAB and/or CRKP detected in the two hospitals, with confirmed co-occurrence and detection at the same anatomical site being the predominant patterns. Respiratory specimens were the major specimen type. Trauma and admission to the Neurology Center, Department of Respiratory and Critical Care Medicine, Trauma Center, Department of Intensive Care Medicine, and Emergency Department were independently associated with CRAB-CRKP co-occurrence.

Citation： CHEN Shujuan, LI Yizhe, SHI Wu, YIN Weijia, ZHU Shichao, QIAO Fu, ZONG Zhiyong. Detection characteristics and factors associated with the co-occurrence of carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae in two hospitals in Sichuan Province, China in 2025. West China Medical Journal, 2026, 41(8): 1277-1281. doi: 10.7507/1002-0179.202602220 Copy

1.	郭燕, 丁麗, 胡付品, 等. 2024 年 CHINET 中國細菌耐藥監測[J]. 中國感染與化療雜志, 2025, 25(6): 597-607.
2.	余鋒, 夏吉林, 劉建. ICU 呼吸機相關性肺炎合并碳青霉烯類耐藥鮑曼不動桿菌及肺炎克雷伯菌感染的一般特征分析[J]. 現代醫藥衛生, 2025, 41(3): 584-587, 593.
3.	Lv D, Zuo Y, Wang Y, et al. Predictors of occurrence and 30-day mortality for co-infection of carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii[J]. Front Cell Infect Microbiol, 2022, 12: 919414.
4.	Sophonsri A, Kelsom C, Lou M, et al. Risk factors and outcome associated with coinfection with carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumanii: a descriptive analysis[J]. Front Cell Infect Microbiol, 2023, 13: 1231740.
5.	Marchaim D, Perez F, Lee J, et al. “Swimming in resistance”: co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa[J]. Am J Infect Control, 2012, 40(9): 830-835.
6.	Snyder GM, O’Fallon E, D’Agata EM. Co-colonization with multiple different species of multidrug-resistant Gram-negative bacteria[J]. Am J Infect Control, 2011, 39(6): 506-510.
7.	World Health Organization. International statistical classification of diseases and related health problems: 10th revision[M]. 6th ed. Geneva: World Health Organization, 2019.
8.	尹維佳, 喬甫, 吳佳玉. 實用醫院感染監測手冊[M]. 成都: 四川大學出版社, 2019: 102-103.
9.	Sarink MJ, Bode LGM, Croughs P, et al. Less is more: when to repeat antimicrobial susceptibility testing[J]. J Clin Microbiol, 2023, 61(8): e00463-23.
10.	Kaushal A, Goyal N, Arora R, et al. Assessment of change in antimicrobial susceptibility pattern of bacteria causing orthopaedic infections by sequential sampling: a prospective cohort study[J]. J Clin Orthop Trauma, 2024, 55: 102510.
11.	K?ck R, Schuler F, Idelevich EA, et al. Variability of antibiograms: how often do changes in the antimicrobial susceptibility pattern occur in isolates from one patient?[J]. Clin Microbiol Infect, 2021, 27(11): 1638-1643.
12.	Park YJ, Lu X, Kim S, et al. Evaluating the adequacy of intervals for repeat antimicrobial susceptibility testing[J]. Ann Clin Microbiol, 2026, 29(2): 7.
13.	Mammina C, Bonura C, Vivoli AR, et al. Co-colonization with carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii in intensive care unit patients[J]. Scand J Infect Dis, 2013, 45(8): 629-634.
14.	蔣滿香, 涂家金, 鐘紅發, 等. 創傷病人合并多重耐藥菌感染現狀及危險因素分析[J]. 護理研究, 2023, 37(5): 833-838.
15.	Russo A, Gullì SP, Garofalo E, et al. Site-specific and time-varying Acinetobacter colonization and risk of invasive infection in critically ill patients[J/OL]. Infection, 2026. DOI: 10.1007/s15010-026-02834-7.
16.	劉敏, 余廣超, 陶勝茹, 等. 耐碳青霉烯類鮑曼不動桿菌及耐碳青霉烯類肺炎克雷伯菌疑似醫院感染暴發調查及防控效果評價[J]. 暨南大學學報(自然科學與醫學版), 2021, 42(6): 616-621.
17.	盧鑫. 神經外科患者術后顱內感染耐碳青霉烯類鮑曼不動桿菌危險因素分析及臨床治療方案探討[D]. 南昌: 南昌大學, 2021.
18.	Huo B, Liu Y, Wei D, et al. Clinical features and microbiological analysis of risk factors for mortality among patients with carbapenem-resistant Klebsiella pneumoniae bacteremia: a changing virulence landscape[J]. J Microbiol Immunol Infect, 2026, 59(4): 486-493.
19.	Lu G, Zhang J, Shi T, et al. Development and application of a nomogram model for the prediction of carbapenem-resistant Klebsiella pneumonia infection in neuro-ICU patients[J]. Microbiol Spectr, 2024, 12(1): e0309623.
20.	Li Y, Gao X, Diao H, et al. Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study[J]. Antimicrob Resist Infect Control, 2024, 13(1): 62.

1. 郭燕, 丁麗, 胡付品, 等. 2024 年 CHINET 中國細菌耐藥監測[J]. 中國感染與化療雜志, 2025, 25(6): 597-607.
2. 余鋒, 夏吉林, 劉建. ICU 呼吸機相關性肺炎合并碳青霉烯類耐藥鮑曼不動桿菌及肺炎克雷伯菌感染的一般特征分析[J]. 現代醫藥衛生, 2025, 41(3): 584-587, 593.
3. Lv D, Zuo Y, Wang Y, et al. Predictors of occurrence and 30-day mortality for co-infection of carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii[J]. Front Cell Infect Microbiol, 2022, 12: 919414.
4. Sophonsri A, Kelsom C, Lou M, et al. Risk factors and outcome associated with coinfection with carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumanii: a descriptive analysis[J]. Front Cell Infect Microbiol, 2023, 13: 1231740.
5. Marchaim D, Perez F, Lee J, et al. “Swimming in resistance”: co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa[J]. Am J Infect Control, 2012, 40(9): 830-835.
6. Snyder GM, O’Fallon E, D’Agata EM. Co-colonization with multiple different species of multidrug-resistant Gram-negative bacteria[J]. Am J Infect Control, 2011, 39(6): 506-510.
7. World Health Organization. International statistical classification of diseases and related health problems: 10th revision[M]. 6th ed. Geneva: World Health Organization, 2019.
8. 尹維佳, 喬甫, 吳佳玉. 實用醫院感染監測手冊[M]. 成都: 四川大學出版社, 2019: 102-103.
9. Sarink MJ, Bode LGM, Croughs P, et al. Less is more: when to repeat antimicrobial susceptibility testing[J]. J Clin Microbiol, 2023, 61(8): e00463-23.
10. Kaushal A, Goyal N, Arora R, et al. Assessment of change in antimicrobial susceptibility pattern of bacteria causing orthopaedic infections by sequential sampling: a prospective cohort study[J]. J Clin Orthop Trauma, 2024, 55: 102510.
11. K?ck R, Schuler F, Idelevich EA, et al. Variability of antibiograms: how often do changes in the antimicrobial susceptibility pattern occur in isolates from one patient?[J]. Clin Microbiol Infect, 2021, 27(11): 1638-1643.
12. Park YJ, Lu X, Kim S, et al. Evaluating the adequacy of intervals for repeat antimicrobial susceptibility testing[J]. Ann Clin Microbiol, 2026, 29(2): 7.
13. Mammina C, Bonura C, Vivoli AR, et al. Co-colonization with carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii in intensive care unit patients[J]. Scand J Infect Dis, 2013, 45(8): 629-634.
14. 蔣滿香, 涂家金, 鐘紅發, 等. 創傷病人合并多重耐藥菌感染現狀及危險因素分析[J]. 護理研究, 2023, 37(5): 833-838.
15. Russo A, Gullì SP, Garofalo E, et al. Site-specific and time-varying Acinetobacter colonization and risk of invasive infection in critically ill patients[J/OL]. Infection, 2026. DOI: 10.1007/s15010-026-02834-7.
16. 劉敏, 余廣超, 陶勝茹, 等. 耐碳青霉烯類鮑曼不動桿菌及耐碳青霉烯類肺炎克雷伯菌疑似醫院感染暴發調查及防控效果評價[J]. 暨南大學學報(自然科學與醫學版), 2021, 42(6): 616-621.
17. 盧鑫. 神經外科患者術后顱內感染耐碳青霉烯類鮑曼不動桿菌危險因素分析及臨床治療方案探討[D]. 南昌: 南昌大學, 2021.
18. Huo B, Liu Y, Wei D, et al. Clinical features and microbiological analysis of risk factors for mortality among patients with carbapenem-resistant Klebsiella pneumoniae bacteremia: a changing virulence landscape[J]. J Microbiol Immunol Infect, 2026, 59(4): 486-493.
19. Lu G, Zhang J, Shi T, et al. Development and application of a nomogram model for the prediction of carbapenem-resistant Klebsiella pneumonia infection in neuro-ICU patients[J]. Microbiol Spectr, 2024, 12(1): e0309623.
20. Li Y, Gao X, Diao H, et al. Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study[J]. Antimicrob Resist Infect Control, 2024, 13(1): 62.

West China Medical Journal

Detection characteristics and factors associated with the co-occurrence of carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae in two hospitals in Sichuan Province, China in 2025

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content