Russo Alessandro, Serapide Francesca, Alessandri Francesco, Gullì Sara Palma, Bruni Andrea, Longhini Federico, Quirino Angela, Morena Rocco, Marascio Nadia, Matera Giovanni, d'Ettorre Gabriella, Zullino Veronica, Mastroianni Claudio Maria, Trecarichi Enrico Maria, Garofalo Eugenio, Ceccarelli Giancarlo
Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italia.
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
Eur J Clin Microbiol Infect Dis. 2025 Apr 28. doi: 10.1007/s10096-025-05137-1.
Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are associated with high morbidity and mortality rates. Furthermore, the role of CRAB respiratory colonization, including multisite colonization, has not yet been adequately highlighted in critically ill patients.
In this retrospective multicenter study, conducted in 4 different Italian hospitals, patients with CRAB respiratory colonization +/- other site who developed or did not develop clinically significant pneumonia from December 2015 to December 2023 were enrolled. The primary objective of the study was to identify risk factors associated with the development of pneumonia.
760 patients were enrolled; among them, 392 (51.5%) developed pneumonia, while 304 (39.9%) patients presented multisite colonization. Overall, in-hospital mortality was 76.3% with a higher mortality (79.6%) in patients who developed pneumonia (p = 0.033). In logistic regression analysis, factors associated with the development of pneumonia included: age, immunosuppressive therapy, COPD, ventilatory support and multisite colonization. A score was developed with AUC 0.72, CI95% 0.68-0.75, p < 0.001 and a sensitivity of 79% and specificity of 55% with a score > 2 and a maximum score of 10 points. Multisite colonization was recorded more frequently in patients who developed pneumonia (51%, p < 0.001). Finally, Kaplan-Meier curves showed a significantly reduced survival at 30 days (p = 0.005) and throughout the hospital stay (p = 0.002) in patients with multisite colonization.
This study highlights the risk factors associated with the development of pneumonia in patients already colonized by CRAB. Multisite colonization showed an important role as a risk factor for the development of pneumonia and for its correlation with mortality.
Not applicable.
耐碳青霉烯类鲍曼不动杆菌（CRAB）感染与高发病率和死亡率相关。此外，CRAB呼吸道定植，包括多部位定植，在重症患者中的作用尚未得到充分重视。
在这项回顾性多中心研究中，选取了意大利4家不同医院中，于2015年12月至2023年12月期间出现或未出现具有临床意义的肺炎的CRAB呼吸道定植伴或不伴有其他部位定植的患者。该研究的主要目的是确定与肺炎发生相关的危险因素。
共纳入760例患者；其中，392例（51.5%）发生了肺炎，而304例（39.9%）患者存在多部位定植。总体而言，住院死亡率为76.3%，发生肺炎的患者死亡率更高（79.6%）（p = 0.033）。在逻辑回归分析中，与肺炎发生相关的因素包括：年龄、免疫抑制治疗、慢性阻塞性肺疾病（COPD）、通气支持和多部位定植。开发了一个评分系统，其曲线下面积（AUC）为0.72，95%置信区间（CI）为0.68 - 0.75，p < 0.001，评分>2时敏感性为79%，特异性为55%，最高评分为10分。发生肺炎的患者中多部位定植更为常见（51%，p < 0.001）。最后，Kaplan - Meier曲线显示，多部位定植患者在30天时（p = 0.005）和整个住院期间（p = 0.002）的生存率显著降低。
本研究强调了已被CRAB定植的患者发生肺炎的相关危险因素。多部位定植作为肺炎发生及其与死亡率相关性的危险因素发挥了重要作用。
不适用。
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