Papathanakos Georgios, Andrianopoulos Ioannis, Papathanasiou Athanasios, Priavali Efthalia, Koulenti Despoina, Koulouras Vasilios
University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece.
Department of Microbiology, Medical School, University of Ioannina, 45110, Ioannina, Greece.
Microorganisms. 2020 Feb 20;8(2):287. doi: 10.3390/microorganisms8020287.
The prevalence of (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively ( = 0.001)), died sooner ( = 0.006), had lower pH ( = 0.004) and higher lactate on ICU admission ( = 0.0001), and had higher APACHE II ( = 0.01) and Charlson Comorbidity Index scores ( = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.
作为医院感染病因的（AB）的患病率一直在上升。不幸的是，新出现的对黏菌素的耐药性限制了治疗选择并影响治疗结果。本研究的目的是证实我们基于临床的假设，即患有对黏菌素耐药的AB（ABCoR）血流感染（BSI）的重症监护病房（ICU）患者会发生暴发性感染性休克并死亡。我们进行了一项为期28个月的回顾性观察研究，纳入了所有在ICU入院时或ICU住院期间发生AB感染的患者。在622名筛查患者中，确定了31名患有BSI败血症的患者。13名（41.9%）患者患有ABCoR BSI，18/31（58.1%）患者患有对黏菌素敏感的（ABCoS）BSI。所有ABCoR BSI患者均死亡；其中，69%（9/13）出现暴发性感染性休克，并在发病后的前3天内死亡。与ABCoS BSI患者相比，ABCoR BSI患者的死亡率更高（分别为100%和50%（ = 0.001）），死亡更早（ = 0.006），在ICU入院时pH值更低（ = 0.004）且乳酸水平更高（ = 0.0001），并且急性生理与慢性健康状况评分系统II（APACHE II）和查尔森合并症指数得分更高（分别为 = 0.01和 = 0.044）。总之，我们记录到患有ABCoR BSI的重症患者表现出暴发性感染性休克且死亡率过高。我们的结果凸显了ICU患者中AB对黏菌素耐药这一新兴的临床问题。
