Objective To investigate the clinical characteristics and bacterial drug resistance of bloodstream infection of gram-negative bacteria, and provide guidance for clinical rational drug use and control of hospital infection. Methods A retrospective analysis was conducted in the patients diagnosed as severe pneumonia with blood culture of gram-negative bacteria from January 2015 to December 2017 in Beijing Anzhen Hospital. Results A total of 60 severe pneumonia patients suffered from bloodstream infection of gram-negative bacteria were recruited including 34 males and 26 females aging from 42 to 89 years and 73.4 years in average. In the 60 patients, 32 cases were infected with Klebsiella pneumonias, 20 cases were infected with Acinetobacter baumanni, and 8 cases were infected with Escherichia coli. The antimicrobial susceptibility testing result of Klebsiella pneumonias showed that the drug susceptibility rate was 100% to tigecycline, and 6.3% to amikacin. Escherichia coli was sensitive to Amikacin, imipenem, ceftazidime and meropenem while resistance to other drugs. The antimicrobial resistance of Acinetobacter baumanni was 28.6% for cefoperazone/sulbactam, and 14.3% for tigecycline. C-reactive protein, procalcitonin and SOFA scores were higher in the patients infected with Acinetobacter baumanni. Neutrophils and blood lactic acid were higher in the patients infected with Klebsiella pneumonias. There were no statistical differences in white blood cell, platelet or motality rate between the patients infected with Acinetobacter baumanni and the patients infected with Klebsiella pneumonias. SOFA scores and blood lactic acid had significantly statistical relevance with prognosis. Conclusion There is a high proportion of drug resistance of Klebsiella pneumoniae and Acinetobacter baumanni in the bloodstream infection of gram-negative bacteria.
ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.
ObjectiveTo explore the prognostic risk factors of bloodstream infections caused by Acinetobacter baumannii in the hospital, to provide a basis for clinical diagnosis and treatment.MethodsA 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.ResultsA 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.ConclusionsThe 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.
ObjectiveTo explore the infection condition of Acinetobacter baumannii at the Neurosurgery Intensive Care Unit (NICU), and analyze the possible risk factors. MethodsWe retrospectively analyzed the clinical data of Acinetobacter baumannii infection patients with craniocerebral injury treated at the NICU between January 2011 and June 2013. We collected such information as infection patients' population distribution, infection site, invasive operations and patients' nurse-in-charge level and so on, and analyzed the possible risk factors for the infection. ResultsThirty-one patients were infected with Acinetobacter baumannii, and they were mainly distributed between 60 and 80 years old. The main infection site was lower respiratory tract, followed in order by urinary tract, gastrointestinal tract, skin and soft tissue. The risk factors might be related to age, invasive operation, nurse working ability, etc. ConclusionThe patients at the NICU are vulnerable to infection of Acinetobacter baumannii. Reducing invasive diagnosis and nursing procedures, providing optimal care, and carrying out specialized nurse standardization training may be the important means to effectively reduce the infection.
Intracranial Acinetobacter baumannii infection is a rare clinical disease with a gradual increase in incidence and extremely high mortality. With the continuous enhancement of bacterial resistance, more and more intracranial infections of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii have appeared in the clinic, and its treatment has become a major challenge and problem faced by neurosurgeons. The treatment difficulties include the selection, usage and dosage of antimicrobial agents, as well as whether cerebrospinal fluid drainage is needed. A standardized treatment plan is still needed. In this paper, combining domestic and foreign literature, the treatment of intracranial infection of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii will be reviewed in order to provide a reference for clinical treatment.
ObjectiveTo investigate the clinical characteristics, treatment and outcomes of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis.MethodsWe retrospectively analyzed the clinical data of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis in the First Affiliated Hospital of Airforce Military University from January 2011 to December 2018. The clinical baseline data, treatment process, microbiological data, antibiotic susceptibility test of the bacterial isolates and outcomes were analyzed.ResultsA total of 10 patients were enrolled, including 4 males and 6 females. The average age of all patients was (44.90±17.03) years, the average age of peritoneal dialysis was (21.70±17.06) months. Seven cases were infected for the first time, and 3 cases were reinfected. The infections were mainly caused by mechanical failure of catheter connection system (3 cases) or enterogenous infection (3 cases). The main symptoms were abdominal pain (10 cases), fever (7 cases) and diarrhea (3 cases). Empirical anti-infective treatment was given after admission, only 1 case was effective, and the treatment of the other 9 cases were adjusted according to the results of drug sensitivity. Acinetobacter baumannii was sensitive to cefoperazone, carbapenem (meropenem, imipenem), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin) and polymyxin. Only one case was resistant to ceftazidime. Among the 10 patients, 8 cases were cured (continued peritoneal dialysis), 1 case died, and 1 case dropped out from peritoneal dialysis to hemodialysis.ConclusionsAcinetobacter baumannii peritoneal dialysis-related peritonitis in this hospital is mainly caused by mechanical disturbance of catheter connection system or enterogenic infection. Appropriate measures, including aseptic standard operation, follow-up and effective anti-infective treatment, should be taken to decrease the incidence and mortality of Acinetobacter baumannii peritoneal dialysis-related peritonitis.
Objective To review the clinical features and trend in antimicrobial resistance of Acinetobacter baumannii (A. baumannii) bloodstream infections. Methods Retrospective analysis was performed by collecting data of underlying diseases, potential risk factors, clinical characteristics, blood test results, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores at onset, bacterial resistance to antibiotics and antimicrobial therapy were collected in Hunan Provincial People’s Hospital from January 2010 to June 2016. Results There were 114 non-duplicated A. baumannii complex blood isolates identified in this research. All patients had at least one underlying disease and accepted at least one surgery or invasive operation within the past 14 days. Multidrug-resistant A. baumannii (MDRAB) was isolated from 89 (78.1%) patients. Of the 114 strains of A. baumannii, 12.3% were resistant to tigecycline, 55.3% to amikacin and 61.4% to cefoperazone-sulbactam. The overall mortality was 51.8% (59/114). The patients with MDRAB had higher mortality rate than those with non-MDRAB (62.9% vs. 12.0%, χ2=20.268, P<0.001). With higher incidence of being in the intensive care unit, intubation/tracheotomy and increased APACHEⅡ score among patients with MDRAB bacteremia (P<0.05). Compared with subjects treated with tigecycline based regimen, those treated with non tigecycline for multidrug resistantA. baumannii had a higher mortality (64.8% vs. 60.0%) but there was no statistical significance (P>0.05). Conclusions The isolated A. baumannii are mainly multidrug resistant and with high mortality. Being in the intensive care unit, increased APACHEⅡ score and intubation/tracheotomy were risk factors for higher mortality among patients with MDRAB bloodstream infection. Tigecycline based regimen doesn’t improve patients’ prognosis.
ObjectiveTo investigate the distribution and drug resistance of Acinetobacter baumannii (AB) in a women and children's hospital. MethodsStrains of AB isolated from clinical specimens between January 2011 and December 2013 were identified with Vitek2-compact microbiology analyzer; antimicrobial susceptibility test was performed by Kirby-Bauer disk diffusion method. The resistant rate, intermediate rate and susceptibility rate of drugs were calculated according to the criteria in guidelines of Clinical and Laboratory Standards Institute. WHONET 5.6 software was used to analyze the data. ResultsA total of 167 strains of AB were isolated and tested. Neonatal ward had the highest detection proportion. Most strains of AB were isolated from sputum. The drug resistance rate of AB to piperacillin tazobactam, cefepime and carbapenem was<25%. ConclusionThe drug sensitivity rate of AB to piperacillin/tazobactam, cefepime and carbapenems was high, but drug resistence to antimicrobial drugs increased continuously in three years. Medical institutions should strengthen the monitoring of AB resistance, implement rational use of antibiotics, and carry out hand hygiene education, to reduce the generation and dissemination of AB resistant strains.
Objective To study the risk factors and prognosis of hospital acquired pneumonia( HAP)caused by carbapenem-resistant Acinetobacter baumannii( CRAB) . Methods By a case-control study, the data of 44 cases of HAP caused by CRAB fromJan 2005 to Dec 2007 in Nanfang Hospital were analyzed. 66 cases of HAP caused by Carbapenem-susceptible A. baumannii ( CSAB) were selected randomly at the same time as control. Univariate analysis( T test and chi-square test) and multivariate logistic regression were used for statistics analysis. Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHE Ⅱ score ≥ 16, chronic pulmonary disease ( COPD/ bronchiectasis ) , imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB, and early combination therapy of antibiotics. Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16( OR=6. 41, 95% CI 2. 20-18. 67) and imipenem/meropenemused 15 days before isolation of CRAB( OR =6. 33,95% CI 1. 83-21. 87) . Of 44 cases of CRAB infections, 14 patients died and 30 patients survived. Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score( CPIS) rise after three-day treatment. According to multivariate logistic regression analysis, only CPIS rise after three-day treatment ( OR =7. 01, 95% CI 1. 23-40. 03) was an independent predictive factor. Conclusions APACHEⅡ score ≥ 16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection. CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.