Division of Infectious Disease, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
J Microbiol Immunol Infect. 2019 Oct;52(5):796-806. doi: 10.1016/j.jmii.2019.03.004. Epub 2019 Apr 12.
We aimed to characterize clinical manifestations of the patients with bacteremia due to community-acquired Acinetobacter baumannii and evaluate the outcomes of these patients.
We conducted a retrospective study to include adult patients with A. baumannii bacteremia and then classified them into two groups: community-acquired A. baumannii bacteremia and hospital-acquired A. baumannii bacteremia. Characteristics and outcomes between 2 groups were compared. The Galleria mellonella infection survival model was used to determine the virulence of A. baumannii in these 2 groups.
There were 63 patients with A. baumannii bacteremia: 21 patients with community-acquired (CA) bacteremia and 42 patients with hospital-acquired (HA) bacteremia. Three patients with CA bacteremia were excluded due to healthcare-associated risks of infection. The remaining 18 patients with CA bacteremia had carbapenem-susceptible A. baumannii (CA-CSAB). Among the 42 patients with HA bacteremia, 11 patients had carbapenem-susceptible A. baumannii (HA-CSAB) and 31 patients had carbapenem-resistant A. baumannii (HA-CRAB). The 30-day mortality rates of those with CA-CSAB did not differ from those with HA-CSAB bacteremia but were significantly lower than those with HA-CRAB (p = 0.003). The factors influencing 30-day mortality were infection with CRAB (p = 0.004), appropriate empirical antimicrobial therapy (p = 0.002), and higher Acute Physiology and Chronic Health Evaluation II score (p < 0.001). The G. mellonella assay showed no differences in survival rates among CA-CSAB, HA-CSAB, and HA-CRAB.
Patients with bacteremia due to CA-CSAB and HA-CSAB had similar outcomes. Similar virulences of CA-CSAB and HA-CSAB were confirmed with the G. mellonella infection model.
本研究旨在对社区获得性鲍曼不动杆菌菌血症患者的临床表现进行分析，并评估这些患者的预后。
我们进行了一项回顾性研究，纳入了成人鲍曼不动杆菌菌血症患者，并将其分为两组：社区获得性鲍曼不动杆菌菌血症和医院获得性鲍曼不动杆菌菌血症。比较两组患者的特征和预后。使用大蜡螟感染生存模型来确定两组中鲍曼不动杆菌的毒力。
共有 63 例鲍曼不动杆菌菌血症患者：21 例为社区获得性（CA）菌血症，42 例为医院获得性（HA）菌血症。3 例 CA 菌血症患者因感染相关的医疗保健风险而被排除。剩余的 18 例 CA 菌血症患者为碳青霉烯敏感的鲍曼不动杆菌（CA-CSAB）。在 42 例 HA 菌血症患者中，11 例为碳青霉烯敏感的鲍曼不动杆菌（HA-CSAB），31 例为碳青霉烯耐药的鲍曼不动杆菌（HA-CRAB）。CA-CSAB 患者的 30 天死亡率与 HA-CSAB 患者的死亡率没有差异，但明显低于 HA-CRAB 患者（p=0.003）。影响 30 天死亡率的因素包括感染 CRAB（p=0.004）、适当的经验性抗菌治疗（p=0.002）和更高的急性生理学和慢性健康评估 II 评分（p<0.001）。大蜡螟试验显示，CA-CSAB、HA-CSAB 和 HA-CRAB 之间的生存率没有差异。
CA-CSAB 和 HA-CSAB 引起的菌血症患者的预后相似。使用大蜡螟感染模型证实了 CA-CSAB 和 HA-CSAB 相似的毒力。
