Article
Author: Chew, Kean Lee ; Xiao, Yonghong ; Evans, Scott ; Garcia-Diaz, Julia ; Liu, Zhengyin ; Xu, Xiaogang ; Evans, Beth ; Valderrama, Sandra ; Rioseco, Maria ; Abbo, Lilian M ; Fries, Bettina C ; Kim, Angela ; Ge, Lizhao ; Vilchez, Samuel ; Chen, Liang ; Wong, Darren ; Bonomo, Robert A ; Huskins, Charles ; McCarty, Todd ; Revolinski, Sara ; Figueroa, Jairo ; Chambers, Henry F ; Perez, Federico ; Ng, Oon Tek ; Westblade, Lars F ; Cross, Heather R ; Li, Linghua ; Dhar, Sorabh ; Lautenbach, Ebbing ; Gutierrez, Jose Millan Oñate ; Tran, Truc T ; Patel, Robin ; Kanj, Souha S ; Ananth Tambyah, Paul ; Patel, Gopi ; Zhang, Fujie ; Jacob, Jesse T ; Cordova, Ezequiel ; Marimuthu, Kalisvar ; Eiras, Daniel ; Peleg, Anton ; Desai, Samit ; Arias, Rebekka ; Xie, Qing ; Yang, Yang ; Satlin, Michael J ; Farrell, John J ; Ostrowsky, Belinda ; Dinh, An Q ; Doi, Yohei ; Spencer, Maria ; Kaye, Keith S ; Eilertson, Brandon ; Gallagher, Jason C ; Weston, Gregory ; De, Partha Pratim ; Anderson, Deverick J ; Wortmann, Glenn ; Smitasin, Nares ; Leroi, Marcel ; Yu, Yunsong ; Panesso, Diane ; Fowler, Vance G ; Jiang, Jianping ; Schmidt-Malan, Suzannah ; Villegas Botero, Maria Virginia ; Han, Jennifer H ; Hanson, Blake ; Munita, Jose M ; Garner, Omai B ; Cober, Eric ; Arias, Cesar A ; Evans, Scott R ; Alenazi, Thamer ; Herc, Erica ; Kreiswirth, Barry N ; Rudin, Susan D ; Richter, Susan ; Sanchez, Marisa L ; Hu, Fupin ; Komarow, Lauren ; Paterson, David L ; Salata, Robert A ; Marshall, Steven H ; Baum, Keri ; Tambyah, Paul Ananth ; Lok, Judith J ; Stryjewski, Martin E ; Diaz, Lorena ; Su, Jiachun ; Zong, Zhiyong ; Li, Lanjuan ; Banerjee, Ritu ; Rydell, Kirsten ; Gao, Hainv ; Salcedo, Soraya ; Di Castelnuovo, Valentina ; Kalayjian, Robert C ; Iovleva, Alina ; Reyes, Jinnethe ; Henderson, Andrew ; Botero, Maria Virginia Villegas ; Stryjewski, Martin ; Greenwood-Quaintance, Kerry ; Wang, Minggui ; Hill, Carol ; Ordoñez, Karen ; van Duin, David ; Waters, Mary ; Manca, Claudia
AbstractBackgroundCarbapenem-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.MethodsIn 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.ResultsOf 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.ConclusionsCRAb 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.