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Ahuatzin-Flores OE, Torres E, Chávez-Bravo E. Acinetobacter baumannii, a Multidrug-Resistant Opportunistic Pathogen in New Habitats: A Systematic Review. Microorganisms 2024; 12:644. [PMID: 38674589 PMCID: PMC11051781 DOI: 10.3390/microorganisms12040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
In recent years, humanity has begun to face a growing challenge posed by a rise in the prevalence of antibiotic-resistant bacteria. This has resulted in an alarming surge in fatalities and the emergence of increasingly hard-to-manage diseases. Acinetobacter baumannii can be seen as one of these resilient pathogens due to its increasing prevalence in hospitals, its resistance to treatment, and its association with elevated mortality rates. Despite its clinical significance, the scientific understanding of this pathogen in non-hospital settings remains limited. Knowledge of its virulence factors is also lacking. Therefore, in this review, we seek to shed light on the latest research regarding the ecological niches, microbiological traits, and antibiotic resistance profiles of Acinetobacter baumannii. Recent studies have revealed the presence of this bacterium in a growing range of environmental niches, including rivers, treatment plants, and soils. It has also been discovered in diverse food sources such as meat and vegetables, as well as in farm animals and household pets such as dogs and cats. This broader presence of Acinetobacter baumannii, i.e., outside of hospital environments, indicates a significant risk of environmental contamination. As a result, greater levels of awareness and new preventive measures should be promoted to address this potential threat to public health.
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Affiliation(s)
- Omar E. Ahuatzin-Flores
- Posgrado en Ciencias Ambientales, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Edificio IC 6. Ciudad Universitaria, Puebla 72570, Mexico;
| | - Eduardo Torres
- Centro de Química, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Puebla 72570, Mexico;
| | - Edith Chávez-Bravo
- Centro de Investigaciones en Ciencias Microbiológicas, Instituto de Ciencias, Benemérita Universidad Autónoma de Puebla, Puebla 72570, Mexico
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Benaissa E, Belouad E, Maleb A, Elouennass M. Risk factors for acquiring Acinetobacter baumannii infection in the intensive care unit: experience from a Moroccan hospital. Access Microbiol 2023; 5:acmi000637.v3. [PMID: 37691842 PMCID: PMC10484316 DOI: 10.1099/acmi.0.000637.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Acinetobacter species are non-fermenting and ubiquitous Gram-negative coccobacilli, which in recent years have become the leading cause of healthcare-associated infections worldwide. Our objective here was to study the epidemiology and risk factors associated with Acinetobacter baumannii infections in the intensive care unit (ICU). Methods This retrospective case-control study was conducted collaboratively between the Medical Bacteriology Department and the two ICUs of the Military Hospital of Instruction Mohammed V-Rabat over a 3 month period. Results We included 180 patients, of whom 60 had A. baumannii infection. We observed a male predominance in both matched groups, with a sex ratio of 1.6. The median age was 67 years [interquartile range (IQR) 59.5-77]. The median length of stay in the ICU before infection was 8.5 days (IQR 5-14). Multivariate logistic regression analysis identified the risk factors statistically associated with A. baumannii infection at the ICU level as follows: duration of invasive procedures >7 days [odds ratio (OR)=1.02], parenteral nutrition (OR=3.514), mechanical ventilation (OR=3.024), imipenem (OR=18.72), colistin (OR=5.645), probabilistic antibiotic therapy >4 days (OR=9.063) and neoplastic pathology (OR=5.727). Conclusion Based on our results, it can be inferred that shortening the duration of stay in the resuscitation setting, implementing rational use of medical devices and optimizing antibiotic therapy could decrease the incidence of these infections.
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Affiliation(s)
- Elmostafa Benaissa
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Elmehdi Belouad
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy (University Mohammed the First), Oujda, Morocco
| | - Mostafa Elouennass
- Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
- Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
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3
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Rojas-Larios F, Martínez-Guerra BA, López-Jácome LE, Bolado-Martínez E, Vázquez-Larios MDR, Velázquez-Acosta MDC, Romero-Romero D, Mireles-Dávalos CD, Quintana-Ponce S, Feliciano-Guzmán JM, Pérez-Hernandez JM, Correa-León YP, López-Gutiérrez E, Rodriguez-Noriega E, González-Díaz E, Choy-Chang EV, Mena-Ramírez JP, Monroy-Colín VA, Ponce-de-León-Garduño A, Alcaraz-Espejel M, Avilés-Benítez LK, Quintanilla-Cazares LJ, Ramírez-Alanís E, Barajas-Magallón JM, Padilla-Ibarra C, Ballesteros-Silva MB, Atanacio-Sixto NA, Morales-de-la-Peña CT, Galindo-Méndez M, Pérez-Vicelis T, Jacobo-Baca G, Moreno-Méndez MI, Mora-Pacheco MDLL, Gutiérrez-Brito M, Sánchez-Godínez XY, Navarro-Vargas NV, Mercado-Bravo LE, Delgado-Barrientos A, Santiago-Calderón MA, López-Ovilla I, Molina-Chavarria A, Rincón-Zuno J, Franco-Cendejas R, Miranda-Mauricio S, Márquez-Avalos IC, López-García M, Duarte-Miranda LS, Cetina-Umaña CM, Barroso-Herrera-Y-Cairo IE, López-Moreno LI, Garza-González E. Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network. Pathogens 2023; 12:1144. [PMID: 37764952 PMCID: PMC10537696 DOI: 10.3390/pathogens12091144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).
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Affiliation(s)
- Fabian Rojas-Larios
- Laboratorio de Microbiología, Hospital Regional Universitario de Colima, Colima 28040, Mexico
| | - Bernardo Alfonso Martínez-Guerra
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| | - Luis Esaú López-Jácome
- Servicio de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Enrique Bolado-Martínez
- Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Hermosillo 83000, Mexico
| | - María Del Rosario Vázquez-Larios
- Laboratorio de Microbiología, Servicio de Infectología y Microbiología Cínica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | | | | | - Christian Daniel Mireles-Dávalos
- Laboratorio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Sandra Quintana-Ponce
- Facultad de Ciencias Naturales, Universidad Autónoma de Guerrero, Chilpancingo 39000, Mexico
| | | | - José Miguel Pérez-Hernandez
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | - Yoselin Paola Correa-León
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | - Eduardo López-Gutiérrez
- Área de Microbiología, Laboratorio Clínico, Hospital Regional de alta Especialidad de Oaxaca, Oaxaca 71256, Mexico
| | - Eduardo Rodriguez-Noriega
- Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Esteban González-Díaz
- Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
- Departamento de Medicina Preventiva, Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara 44280, Mexico
| | - Elena Victoria Choy-Chang
- Departamento de Bacteriología, Hospital General de Zona No.1 IMSS "Nueva Frontera", Tapachula 30767, Mexico
| | - Juan Pablo Mena-Ramírez
- Laboratorio de Microbiología, Hospital General de Zona No. 21 IMSS, Centro Universitario de los Altos (CUALTOS), Universidad de Guadalajara, Tepatitlán de Morelos 47630, Mexico
| | | | - Alfredo Ponce-de-León-Garduño
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| | | | - Laura Karina Avilés-Benítez
- Laboratorio de Microbiología y Parasitología, Hospital Infantil de Morelia "Eva Sámano de López Mateos", Morelia 58253, Mexico
| | | | | | | | - Cecilia Padilla-Ibarra
- Laboratorio Clínico, Hospital General de Estado "Dr. Ernesto Ramos Bours", Hermosillo 83000, Mexico
| | | | | | | | | | - Talía Pérez-Vicelis
- Hospital Regional de Alta Especialidad Bicentenario de la Independencia, Tultitlán 54916, Mexico
| | - Guillermo Jacobo-Baca
- Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | | | | | | | | | | | | | | | | | - Ismelda López-Ovilla
- Hospital Chiapas Nos Une Dr. Jesús Gilberto Gómez Maza, Tuxtla Gutiérrez 29045, Mexico
| | | | - Joaquín Rincón-Zuno
- Instituto Materno Infantil del Estado de México, Toluca de Lerdo 50170, Mexico
| | - Rafael Franco-Cendejas
- Servicio de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | | | | | - Maribel López-García
- Hospital de la Madre y el Niño Guerrerense, Chilpancingo de los Bravo 39075, Mexico
| | | | | | | | | | - Elvira Garza-González
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
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Calix JJ, de Almeida MCS, Potter RF, Wallace MA, Burnham CAD, Dantas G. Outpatient Clonal Propagation and Rapid Regional Establishment of an Emergent Carbapenem-Resistant Acinetobacter baumannnii Lineage Sequence Type 499Pas. J Infect Dis 2023; 227:631-640. [PMID: 36301240 PMCID: PMC10152498 DOI: 10.1093/infdis/jiac427] [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: 06/27/2022] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Eliminating carbapenem-resistant Acinetobacter baumannii (CRAb) disease requires comprehensive knowledge of how this noncommensal organism propagates among at-risk hosts. We molecularly characterized an ongoing surge of CRAb cases among patients in a Midwest US healthcare system, which coincided with sustained reductions in hospital-acquired CRAb infections and falloffs of cases associated with distinctly more resistant antibiotypes. Genome sequencing revealed surge isolates belonged to an emergent Pasteur scheme sequence type 499 and comprised multiple contemporaneous clonal clusters. Detailed query of health records revealed no consistent hospital source but instead identified various outpatient healthcare settings linked to cluster cases. We show that CRAb can rapidly establish a regional presence even without gains in breadth of antibiotic resistance and negligible contribution from sustained intrahospital transmission. As CRAb lineages may sidestep control efforts via outpatient epidemiological niches, our approach can be implemented to investigate outpatient CRAb propagation and inform subsequent local surveillance outside hospital settings.
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Affiliation(s)
- Juan J Calix
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | | | - Robert F Potter
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Carey-Ann D Burnham
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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5
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Bai B, Eales BM, Huang W, Ledesma KR, Merlau PR, Li G, Yu Z, Tam VH. Clinical and genomic analysis of virulence-related genes in bloodstream infections caused by Acinetobacter baumannii. Virulence 2022; 13:1920-1927. [PMID: 36308002 PMCID: PMC9621070 DOI: 10.1080/21505594.2022.2132053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Acinetobacter baumannii has emerged as a common cause of bloodstream infections, which is associated with high mortality and long periods of hospitalization. To advance the medical care of our patients, the study was designed to identify microbial characteristics associated with poor clinical outcomes. A collection of 32 A. baumannii bloodstream isolates with diverse genetic backgrounds (as determined by multilocus sequence typing) was studied. These isolates were recovered by unique patients (18 males, 14 females; age range: 17 days to 87 years) between 2011 and 2018. A sequential screening approach (cross-referencing analyses using different endpoints) was used to identify isolates with the best correlation between bacterial virulence and clinical prognosis. Isolates associated with more rapid in vitro growth rate, shorter median survival time in pre-clinical infection models, and hospital mortality were selected as candidates for high virulence, while those with opposite characteristics were selected as controls with low virulence. Whole genome sequencing was undertaken in the most promising clinical isolates. We found five virulence genes (beta-hemolysin/cytolysin, Cpi-1a + Cpi-1 (SPI-1 like), enhanced entry proteins, FbpABC, Paa) and 1 secretory system (T6SS) only present in a highly virulent isolate (AB23), compared to a low virulence control isolate (AB6). These genetic elements could be associated with the poor prognosis of A. baumannii bacteraemia and further investigations are warranted.
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Affiliation(s)
- Bing Bai
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, Shenzhen, Guangdong, China,Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA
| | - Brianna M. Eales
- Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA
| | - Wei Huang
- Bacteriology & Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Kimberly R. Ledesma
- Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA
| | - Paul R. Merlau
- Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA
| | - Guiqiu Li
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, Shenzhen, Guangdong, China
| | - Zhijian Yu
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, The 6th Affiliated Hospital of Shenzhen University Health Center, Shenzhen, Guangdong, China,Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA
| | - Vincent H. Tam
- Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA,CONTACT Vincent H. Tam
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Wang J, Zhang J, Wu ZH, Liu L, Ma Z, Lai CC, Luo YG. Clinical Characteristics and Prognosis Analysis of Acinetobacter baumannii Bloodstream Infection Based on Propensity Matching. Infect Drug Resist 2022; 15:6963-6974. [PMID: 36474906 PMCID: PMC9719707 DOI: 10.2147/idr.s387898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/14/2022] [Indexed: 09/13/2023] Open
Abstract
PURPOSE In view of the fact that Acinetobacter baumannii bloodstream infection(BSI) is a great threat to human survival, early identification of the risk factors affecting prognosis will be of great benefit to the clinic. PATIENTS AND METHODS A propensity score matching method was used to collect patients identified with Acinetobacter baumannii BSI from 2016 to 2020 from a reputable hospital in China. RESULTS A total of 398 patients were considered. According to the 28-day prognosis, they were divided into the survival group 150 (37.7%) and the death group 248 (62.3%), and the prognosis was analyzed. Subsequently, Propensity score matching was adjusted for variables with p-values CONCLUSION The existence of drug resistance with Acinetobacter baumannii only leads to Inappropriate empirical antibiotic therapy, ultimately, Inappropriate empirical antibiotic therapy was the direct predictor of mortality.
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Affiliation(s)
- Jinghui Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Jun Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zhuang-hao Wu
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Lei Liu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zijun Ma
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Cheng-cheng Lai
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yong-gang Luo
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Lynch JP, Clark NM, Zhanel GG. Infections Due to Acinetobacter baumannii-calcoaceticus Complex: Escalation of Antimicrobial Resistance and Evolving Treatment Options. Semin Respir Crit Care Med 2022; 43:97-124. [PMID: 35172361 DOI: 10.1055/s-0041-1741019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bacteria within the genus Acinetobacter (principally A. baumannii-calcoaceticus complex [ABC]) are gram-negative coccobacilli that most often cause infections in nosocomial settings. Community-acquired infections are rare, but may occur in patients with comorbidities, advanced age, diabetes mellitus, chronic lung or renal disease, malignancy, or impaired immunity. Most common sites of infections include blood stream, skin/soft-tissue/surgical wounds, ventilator-associated pneumonia, orthopaedic or neurosurgical procedures, and urinary tract. Acinetobacter species are intrinsically resistant to multiple antimicrobials, and have a remarkable ability to acquire new resistance determinants via plasmids, transposons, integrons, and resistance islands. Since the 1990s, antimicrobial resistance (AMR) has escalated dramatically among ABC. Global spread of multidrug-resistant (MDR)-ABC strains reflects dissemination of a few clones between hospitals, geographic regions, and continents; excessive antibiotic use amplifies this spread. Many isolates are resistant to all antimicrobials except colistimethate sodium and tetracyclines (minocycline or tigecycline); some infections are untreatable with existing antimicrobial agents. AMR poses a serious threat to effectively treat or prevent ABC infections. Strategies to curtail environmental colonization with MDR-ABC require aggressive infection-control efforts and cohorting of infected patients. Thoughtful antibiotic strategies are essential to limit the spread of MDR-ABC. Optimal therapy will likely require combination antimicrobial therapy with existing antibiotics as well as development of novel antibiotic classes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology; Department of Medicine; The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nina M Clark
- Division of Infectious Diseases, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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Time to Strategically Position Nursing Homes to Effectively Manage Emerging Infections. J Am Med Dir Assoc 2020; 21:1578-1579. [PMID: 32807656 PMCID: PMC7428431 DOI: 10.1016/j.jamda.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
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Almasaudi SB. Acinetobacter spp. as nosocomial pathogens: Epidemiology and resistance features. Saudi J Biol Sci 2018; 25:586-596. [PMID: 29686523 PMCID: PMC5910652 DOI: 10.1016/j.sjbs.2016.02.009] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 11/14/2022] Open
Abstract
The genus Acinetobacter is a major cause of nosocomial infections; it is increasingly being associated with various epidemics and has become a widespread concern in a variety of hospitals worldwide. Multi-antibiotic resistant Acinetobacter baumannii, is now recognized to be of great clinical significance. Numerous reports relay to the spread of A. baumannii in the hospital settings which leads to enhanced nosocomial outbreaks associated with high death rates. However, many other Acinetobacter spp. also can cause nosocomial infections. This review focused on the role of Acinetobacter spp. as nosocomial pathogens in addition to their persistence, antimicrobial resistance patterns and epidemiology.
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Affiliation(s)
- Saad B. Almasaudi
- Biology Department, Faculty of Science, King Abdulaziz University (KAU), P.O. Box 80203, Jeddah 21589, Saudi Arabia
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10
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Uwingabiye J, Lemnouer A, Baidoo S, Frikh M, Kasouati J, Maleb A, Benlahlou Y, Bssaibis F, Mbayo A, Doghmi N, Abouelalaa K, Baite A, Ibrahimi A, Elouennass M. Intensive care unit-acquired Acinetobacter baumannii infections in a Moroccan teaching hospital: epidemiology, risk factors and outcome. Germs 2017; 7:193-205. [PMID: 29264357 DOI: 10.18683/germs.2017.1126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/25/2017] [Accepted: 12/01/2017] [Indexed: 01/16/2023]
Abstract
Introduction The objective of this study was to examine the epidemiology, risk factors and outcome associated with Acinetobacter baumannii infections in the intensive care units (ICUs) in a Moroccan teaching hospital. Methods This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016. Results Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed A. baumannii infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired A. baumannii infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with A. baumannii infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with A. baumannii infection. Conclusion Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.
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Affiliation(s)
- Jean Uwingabiye
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Abdelhay Lemnouer
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Sabina Baidoo
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mohammed Frikh
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Jalal Kasouati
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Adil Maleb
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Yassine Benlahlou
- PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Fatna Bssaibis
- Msc, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Albert Mbayo
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Nawfal Doghmi
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Khalil Abouelalaa
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Abdelouahed Baite
- MD, Department of Intensive Care Units, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Azeddine Ibrahimi
- PhD, Medical Biotechnology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mostafa Elouennass
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
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Nosocomial Outbreak of Extensively Drug-Resistant Acinetobacter baumannii Isolates Containing blaOXA-237 Carried on a Plasmid. Antimicrob Agents Chemother 2017; 61:AAC.00797-17. [PMID: 28893775 DOI: 10.1128/aac.00797-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/22/2017] [Indexed: 11/20/2022] Open
Abstract
Carbapenem antibiotics are among the mainstays for treating infections caused by Acinetobacter baumannii, especially in the Northwest United States, where carbapenem-resistant A. baumannii remains relatively rare. However, between June 2012 and October 2014, an outbreak of carbapenem-resistant A. baumannii occurred in 16 patients from five health care facilities in the state of Oregon. All isolates were defined as extensively drug resistant. Multilocus sequence typing revealed that the isolates belonged to sequence type 2 (international clone 2 [IC2]) and were >95% similar as determined by repetitive-sequence-based PCR analysis. Multiplex PCR revealed the presence of a blaOXA carbapenemase gene, later identified as blaOXA-237 Whole-genome sequencing of all isolates revealed a well-supported separate branch within a global A. baumannii phylogeny. Pacific Biosciences (PacBio) SMRT sequencing was also performed on one isolate to gain insight into the genetic location of the carbapenem resistance gene. We discovered that blaOXA-237, flanked on either side by ISAba1 elements in opposite orientations, was carried on a 15,198-bp plasmid designated pORAB01-3 and was present in all 16 isolates. The plasmid also contained genes encoding a TonB-dependent receptor, septicolysin, a type IV secretory pathway (VirD4 component, TraG/TraD family) ATPase, an integrase, a RepB family plasmid DNA replication initiator protein, an alpha/beta hydrolase, and a BrnT/BrnA type II toxin-antitoxin system. This is the first reported outbreak in the northwestern United States associated with this carbapenemase. Particularly worrisome is that blaOXA-237 was carried on a plasmid and found in the most prominent worldwide clonal group IC2, potentially giving pORAB01-3 great capacity for future widespread dissemination.
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Ballouz T, Aridi J, Afif C, Irani J, Lakis C, Nasreddine R, Azar E. Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia. Front Cell Infect Microbiol 2017; 7:156. [PMID: 28523249 PMCID: PMC5415554 DOI: 10.3389/fcimb.2017.00156] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/12/2017] [Indexed: 11/27/2022] Open
Abstract
Infections caused by Acinetobacter baumannii (AB), an increasingly prevalent nosocomial pathogen, have been associated with high morbidity and mortality. We conducted this study to analyze the clinical features, outcomes, and factors influencing the survival of patients with AB bacteremia. We retrospectively examined the medical records of all patients developing AB bacteremia during their hospital stay at a tertiary care hospital in Beirut between 2010 and 2015. Ninety episodes of AB bacteremia were documented in eighty-five patients. Univariate analysis showed that prior exposure to high dose steroids, diabetes mellitus, mechanical ventilation, prior use of colistin and tigecycline, presence of septic shock, and critical care unit stay were associated with a poor outcome. High dose steroids and presence of septic shock were significant on multivariate analysis. Crude mortality rate was 63.5%. 70.3% of the deaths were attributed to the bacteremia. On acquisition, 39 patients had septicemia. Despite high index of suspicion and initiation of colistin and/or tigecycline in 18/39 patients, a grim outcome could not be averted and 37 patients died within 2.16 days. Seven patients had transient benign bacteremia; three of which were treated with removal of the line. The remaining four did not receive any antibiotics due to withdrawal of care and died within 26.25 days of acquiring the bacteremia, with no signs of persistent infection on follow up. A prolonged hospital stay is frequently associated with loss of functionality, and steroid and antibiotic exposure. These factors seem to impact the mortality of AB bacteremia, a disease with high mortality rate and limited therapeutic options.
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Affiliation(s)
- Tala Ballouz
- Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon
| | - Jad Aridi
- Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon
| | - Claude Afif
- Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon
| | - Jihad Irani
- Department of Family Medicine, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon
| | - Chantal Lakis
- Faculty of Medicine, University of BalamandBeirut, Lebanon
| | - Rakan Nasreddine
- Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon
| | - Eid Azar
- Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon
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Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action. J Am Med Dir Assoc 2016; 17:183.e1-16. [PMID: 26778488 DOI: 10.1016/j.jamda.2015.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
Abstract
Antimicrobial resistance is a global public health crisis and a national security threat to the United States, as stated in an executive order signed by the president in September 2014. This crisis is a result of indiscriminant antimicrobial use, which promotes selection for resistant organisms, increases the risk of adverse drug events, and renders patients vulnerable to drug-resistant infections. Antimicrobial stewardship is a key measure to combat antimicrobial resistance and specifically seeks to do this by improving antimicrobial use. Antimicrobial stewardship compliments infection control practices and it is important to note that these 2 disciplines are distinct and cannot be discussed interchangeably. Antimicrobial stewardship promotes the appropriate diagnosis, drug, dose, and duration of treatment. The appropriate diagnosis falls into the hands of the prescriber and clinical staff. Optimal antimicrobial drug selection, dosing strategy, and duration of treatment, however, often require expertise in antimicrobial therapy, such as an infectious disease-trained physician or pharmacist. Therefore, successful antimicrobial stewardship programs must be comprehensive and interdisciplinary. Most antimicrobial stewardship programs focus on hospitals; yet, in long-term care, up to 75% of antimicrobial use is inappropriate or unnecessary. Thus, one of the most pressing areas in need for antimicrobial stewardship is in long-term care facilities. Unfortunately, there is little evidence that describes effective antimicrobial stewardship interventions in this setting. This review discusses the need for and barriers to antimicrobial stewardship in long-term care facilities. Additionally, this review describes prior interventions that have been implemented and tested to improve antimicrobial use in long-term care facilities.
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