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Tziolos RN, Karakonstantis S, Kritsotakis EI, Vassilopoulou L, Loukaki M, Tovil A, Kokkini S, Tryfinopoulou K, Ioannou P, Kondili E, Kofteridis D. Limited Impact of Colistin Resistance on Mortality of Intensive Care Patients with Carbapenem-resistant Bacteraemia. J Hosp Infect 2024:S0195-6701(24)00272-X. [PMID: 39154897 DOI: 10.1016/j.jhin.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/16/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Increasing incidence of carbapenem-resistant Gram-negative bacteraemia (CR-GNB) has triggered increased use of polymyxins, likely fuelling the emergence and spread of colistin resistance. AIM To estimate the excess clinical burden of colistin resistance in intensive care patients with CR-GNB. METHODS A cohort was constructed of patients with CR-GNB during their stay in the intensive care unit (ICU) of a university hospital in Greece, over a 4-year period (2020-2023). Competing risks survival analysis was performed to estimate the burden associated with colistin resistance. FINDINGS In 177 ICU patients with CR-GNB, 134 (76%) had colistin-resistant isolates, predominantly Acinetobacter baumannii (79%), identified by broth microdilution. Patients with colistin resistant infection were similar to those with colistin susceptible with respect to age, sex, APACHE II score, Charlson comorbidity index, Pitt bacteraemia score, prior surgery and the occurrence of polymicrobial cultures. However, patients in the colistin resistant group had lower mortality risk compared to the colistin susceptible (31% vs. 44%, P = 0.004 at 14 days; 46% vs. 56% at 28 days, P = 0.173; respectively). Multivariable regression analysis confirmed that colistin resistant CR-GNB was associated with significantly lower hazard of inpatient death compared to colistin susceptible infection at 14 days (cause-specific hazard ratio [csHR], 0.53; 95% CI 0.28 - 1.01) and 28 days (csHR, 0.55; 95% CI 0.31 - 0.95) of infection onset. CONCLUSION Limited impact of colistin resistance on mortality was demonstrated in a large contemporary cohort of ICU patients with CR-GNB, possibly reflecting the recent shift away from colistin-based treatment regimens.
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Affiliation(s)
- Renatos-Nikolaos Tziolos
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Stamatis Karakonstantis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Loukia Vassilopoulou
- 2(nd) Department of Internal Medicine, Venizeleio General Hospital, Heraklion, Greece
| | - Maria Loukaki
- 2(nd) Department of Internal Medicine, Venizeleio General Hospital, Heraklion, Greece
| | - Alberto Tovil
- 2(nd) Department of Internal Medicine, Venizeleio General Hospital, Heraklion, Greece
| | - Sophia Kokkini
- Department of Intensive Care Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Kyriaki Tryfinopoulou
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, Greece
| | - Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Eumorfia Kondili
- Department of Intensive Care Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Diamantis Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece.
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Suh JW, Park SM, Ju YK, Yang KS, Kim JY, Kim SB, Sohn JW, Yoon YK. Clinical and molecular predictors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: A retrospective cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:148-155. [PMID: 38057202 DOI: 10.1016/j.jmii.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND/PURPOSE To investigate the virulence profiles and identify clinical and microbiological predictors of mortality in patients with carbapenem-resistant Acinetobacter baumannii (A. baumannii) bacteremia. METHODS This retrospective cohort study enrolled adult patients with carbapenem-resistant A. baumannii (CRAB). Multivariate logistic regression was used to identify the predictors of 30-day mortality. All isolates were subjected to real-time polymerase chain reaction for virulence factors and genotyped using multilocus sequence typing. RESULTS Among the 153 patients with CRAB bacteremia, 66 % received appropriate definitive antibiotic therapy. The in-hospital and 30-day mortality rates were 58.3 and 23.5 %, respectively. Ultimately, we enrolled 125 patients with CRAB bacteremia in the analysis, excluding early mortality cases. All CRAB isolates carried blaOXA-23 and blaOXA-51. The clinical strains belonged to 10 sequence types (STs), and the major genotypes were ST191, ST195, ST451, and ST784. The distribution of virulence factors included surface adhesion (Ata, 84.8 %; ChoP, 7.2 %), biofilm formation (OmpA, 76.8 %), killing of host cells (AbeD, 99.2 %), toxins (LipA, 99.2 %), and conjugation (BfmR, 90.4 %). In multivariate logistic regression analysis, hemodialysis due to acute kidney injury and moderate to severe thrombocytopenia were significant risk factors associated with 30-day mortality. However, microbiological factors were not significant predictors. CONCLUSIONS Clinical factors such as hemodialysis due to acute renal injury and moderate to severe thrombocytopenia have a greater influence on mortality in CRAB bacteremia compared with microbiological factors.
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Affiliation(s)
- Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Min Park
- Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Yong Kuk Ju
- Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeong Yeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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Inai K, Higuchi S, Shimada A, Hisada K, Hida Y, Hatta S, Kitano F, Uno M, Matsukawa H, Noriki S, Iwasaki H, Naiki H. Exploration of sepsis assisting parameters in hospital autopsied-patients: a prospective study. Sci Rep 2023; 13:10681. [PMID: 37393368 PMCID: PMC10314941 DOI: 10.1038/s41598-023-37752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023] Open
Abstract
Although Sepsis-3 doesn't require evidence of bacteremia to diagnose sepsis, clinicians often want to identify the causative pathogen at autopsy. In principle, if the blood cultures are the same at ante- and postmortem, the cause of death is obvious. However, interpretations of postmortem blood cultures are often difficult due to discordance, negativity, mixed infection, and contamination, of pathogens occupying ≥ 50% of the tests. To increase specificity identifying agonal phase sepsis in the situations where blood cultures are discordant, multiple or negative at postmortem, we established a scoring system using blood cultures, procalcitonin (PCN) showing highest sensitivity and specificity for postmortem serum, and bone marrow polyhemophagocytosis (PHP). Histological sepsis showed significantly higher levels of culture score (2.3 ± 1.5 vs. 0.4 ± 0.5, p < 0.001), PHP score (2.5 ± 0.8 vs. 1.0 ± 1.1, p < 0.001), and PCN score (1.8 ± 0.8 vs. 0.8 ± 0.6, p < 0.01) than non-septic patients. Receiver operating characteristic curve analysis indicated that estimation of three scores was the most reliable indicator for recognizing agonal phase sepsis. These findings suggest that the combination of these three inspections enables to determine the pathological diagnoses of sepsis even it is not obvious by discordant, mixed or negative blood cultures.
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Affiliation(s)
- Kunihiro Inai
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Shohei Higuchi
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Akihiro Shimada
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Kyoko Hisada
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Yukio Hida
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Satomi Hatta
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Fumihiro Kitano
- Division of Rural Medicine, School of Medical Sciences, University of Fukui, Fukui, Japan
| | - Miyuki Uno
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Haruka Matsukawa
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Sakon Noriki
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, Fukui, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control, University of Fukui Hospital, Fukui, Japan
| | - Hironobu Naiki
- Division of Molecular Pathology, Department of Pathological Sciences, School of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
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Karakonstantis S, Ioannou P, Kritsotakis EI. Co-isolates of Acinetobacter baumannii complex in polymicrobial infections: a meta-analysis. Access Microbiol 2022; 4:acmi000348. [PMID: 36003364 PMCID: PMC9394532 DOI: 10.1099/acmi.0.000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/24/2022] [Indexed: 01/01/2023] Open
Abstract
Background.Acinetobacter baumannii complex (ABC) infections are commonly polymicrobial. Examining which pathogens are most commonly co-isolated with ABC is an important first step for assessing disease potential due to pathogen-pathogen interactions. Methods. Based on a systematic search of PubMed, Scopus and CENTRAL, we estimated percent proportions of co-isolates in polymicrobial pulmonary and bloodstream ABC infections using random-effects meta-analysis.
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Affiliation(s)
- Stamatis Karakonstantis
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Internal Medicine, Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Petros Ioannou
- Department of Internal Medicine, Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Evangelos I. Kritsotakis
- School of Health and Related Research, Faculty of Medicine, Dentistry and Health, The University of Sheffield, Sheffield, UK
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Karakonstantis S, Kritsotakis EI. Systematic review and meta-analysis of the proportion and associated mortality of polymicrobial (vs monomicrobial) pulmonary and bloodstream infections by Acinetobacter baumannii complex. Infection 2021; 49:1149-1161. [PMID: 34260054 DOI: 10.1007/s15010-021-01663-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Differentiating Acinetobacter baumannii complex (ABC) infection from colonization remains difficult and further complicated in polymicrobial infections. PURPOSE To assess the frequency of polymicrobial ABC infections and associated mortality. We hypothesized a lower mortality in polymicrobial infections if ABC isolation reflects colonization in some polymicrobial infections. METHODS A systematic review was conducted in PubMed, Scopus and CENTRAL for studies reporting ABC pulmonary and bloodstream infections. The proportion of infections that were polymicrobial and the magnitude of the association between polymicrobial (vs monomicrobial) infection and mortality were estimated with meta-analyses. RESULTS Based on 80 studies (9759 infections) from 23 countries, the pooled proportion of polymicrobial infection was 27% (95% CI 22-31%) and was similarly high for bloodstream and pulmonary infections. Polymicrobial infection was variably and insufficiently defined in most (95%) studies. Considerable heterogeneity (I2 = 95%) was observed that persisted in subgroup analyses and meta-regressions. Based on 17 studies (2675 infections), polymicrobial infection was associated with lower 28-day mortality (OR = 0.75, 95% CI 0.58-0.98, I2 = 36%). However, polymicrobial infection was not associated with in-hospital mortality (OR = 0.97, 95% CI 0.69-1.35, I2 = 0%) based on 14 studies (953 infections). The quality of evidence (GRADE) for the association of polymicrobial (vs monomicrobial) infection with mortality was low and at high risk of bias. CONCLUSION Polymicrobial ABC infections are common and may be associated with lower 28-day mortality. Considering the heterogeneity of polymicrobial infections and limitations of the available literature, more research is required to clarify the clinical impact of polymicrobial (vs monomicrobial) ABC infection.
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Affiliation(s)
- Stamatis Karakonstantis
- Department of Internal Medicine, Infectious Diseases, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece.
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece
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