Clinical Outcomes and Bacterial Characteristics of Carbapenem-resistant <i>Acinetobacter baumannii</i> Among Patients From Different Global Regions
Minggui Wang, Lizhao Ge, Liang Chen, Lauren Komarow, Blake Hanson, Jinnethe Reyes, Eric Cober, Thamer H. Alenazi, Zhiyong Zong, Qing Xie, Zhengyin Liu, Lanjuan Li, Yunsong Yu, Hainv Gao, Souha S. Kanj, Jairo Figueroa, Erica Herc, Ezequiel Córdova, Gregory Weston, Paul Anantharajah Tambyah, Julia Garcia‐Diaz, Keith S. Kaye, Sorabh Dhar, José M. Munita, Robert A. Salata, Samuel Vilchez, Martín E. Stryjewski, María Virginia Villegas, Alina Iovleva, Scott Evans, Keri Baum, Carol Hill, Barry N. Kreiswirth, Robin Patel, David L. Paterson, Cesar A Arias, Robert A. Bonomo, Henry F. Chambers, Vance G. Fowler, Michael J. Satlin, David van Duin, Yohei Doi, Multi-Drug Resistant Organism Network Investigators, Souha S. Kanj, Fujie Zhang, Judith J. Lok, Robert A. Salata, Martín E. Stryjewski, Valentina Di Castelnuovo, Jose Millan Oñate Gutierrez, Eric Cober, Susan Richter, Deverick J. Anderson, Beth Evans, Carol Hill, H. R. Cross, Keri Baum, Rebekka M. Arias, Vance G Fowler, Karen Ordóñez, Jesse T. Jacob, Linghua Li, Barry N Kreiswirth, Claudia Manca, Liang Chen, Samit Desai, Erica Herc, Ezequiel Córdova, María Luisa Rioseco, Samuel Vilchez, Marisa Sánchez, Sandra Valderrama, Jairo Figueroa, Cesar A Arias, An Q Dinh, Diane Panesso, Kirsten Rydell, Truc T. Tran, Fupin Hu, Jiachun Su, Jianping Jiang, Minggui Wang, Xiaogang Xu, Yang Yang, José M. Munita, María Spencer, Thamer H. Alenazi, Robert A. Bonomo, Steven H. Marshall, Susan D. Rudin, W. Charles Huskins, Kerry Greenwood-Quaintance, Robin Patel, Suzannah M. Schmidt-Malan, Sara Revolinski, Glenn Wortmann, Robert C. Kalayjian, Gregory Weston, Belinda Ostrowsky, Gopi Patel
Abstract
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAb) is 1 of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb. METHODS: In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis. RESULTS: Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases. CONCLUSIONS: CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinical Trials Registration. NCT03646227.