1887

Access Microbiology open research platform logo

Volume 6, Issue 9

Retrospective analysis of bacteraemia risk factors, complications and mortality in a tertiary university hospital in Saudi Arabia Open Access

Abstract

There are many multidrug-resistant isolates of the nosocomial pathogen, , causing severe healthcare-acquired infections in terminally ill patients with high mortality and morbidity rates.

This study aims to retrospectively analyse bacteraemia (ABB) cases in Saudi Arabia, where the information is sparse regarding the prevalence, risk factors, clinical disease, antibiotic regimen, antibiotic susceptibility, treatment outcomes and mortality associated with this infection.

A retrospective chart review was conducted between 1 January 2015 and 31 December 2022 to identify all patients aged 14 years and above with ABB. Demographic and clinical data, as well as results from laboratory analyses, were collected from patients’ electronic charts. Statistical analyses were performed on the data to identify factors associated with 90-day mortality.

Of the 122 ABB cases, 71 (63.4%) died. The factors that were found to be associated with 90-day mortality were the Charlson Comorbidity Index, Pitt bacteraemia score, quick Sequential Organ Failure Assessment score (<0.001 for each), hospital ward (<0.02), short duration of antibiotic treatment (<0.01) and higher age (<0.05). The most common source of infection was central line-associated bloodstream infection in 52.7%. Also associated with mortality were inappropriate antimicrobial therapy (<0.02) and empirical use of colistin (<0.05). In many patients, ABB was caused by carbapenem-resistant [(CRAB), 69.6%], and 74.4% of those patients died.

To prevent ABB-associated mortality, an appropriate regimen and duration of treatment are necessary. Hospitals should also practice proper hygiene to prevent the spread of ABB. CRAB is a growing threat in hospitals in Saudi Arabia, especially in the critical care setting, and carries a very high risk of mortality.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Acinetobacter , antibiotics , bacteraemia , mortality , resistance and risk factors
© 2024 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.000826.v4
2024-09-30
2024-10-05
Loading full text...

Full text loading...

/deliver/fulltext/acmi/6/9/acmi000826.v4.html?itemId=/content/journal/acmi/10.1099/acmi.0.000826.v4&mimeType=html&fmt=ahah

References

  1. Towner KJ. Acinetobacter: an old friend, but a new enemy. J Hosp Infect 2009; 73:355–363 [View Article] [PubMed]
     [Google Scholar]
  2. Bouvet PJM, Grimont PAD. Taxonomy of the genus Acinetobacter with the recognition of Acinetobacter baumannii sp. nov., Acinetobacter haemolyticus sp. nov., Acinetobacter johnsonii sp. nov., and Acinetobacter junii sp. nov. and emended descriptions of Acinetobacter calcoaceticus and Acinetobacter lwoffii. Int J Syst Bacteriol 1986; 36:228–240 [View Article]
     [Google Scholar]
  3. Al Atrouni A, Joly-Guillou M-L, Hamze M, Kempf M. Reservoirs of non-baumannii Acinetobacter Species. Front Microbiol 2016; 7:49 [View Article] [PubMed]
     [Google Scholar]
  4. Turton JF, Shah J, Ozongwu C, Pike R. Incidence of Acinetobacter species other than A. baumannii among clinical isolates of Acinetobacter: evidence for emerging species. J Clin Microbiol 2010; 48:1445–1449 [View Article] [PubMed]
     [Google Scholar]
  5. Adewoyin MA, Okoh AI. The natural environment as a reservoir of pathogenic and non-pathogenic Acinetobacter species. Rev Environ Health 2018; 33:265–272 [View Article] [PubMed]
     [Google Scholar]
  6. Wong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B et al. Clinical and pathophysiological overview of Acinetobacter infections: a century of challenges. Clin Microbiol Rev 2017; 30:409–447 [View Article] [PubMed]
     [Google Scholar]
  7. Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol 2007; 5:939–951 [View Article] [PubMed]
     [Google Scholar]
  8. Sahl JW, Gillece JD, Schupp JM, Waddell VG, Driebe EM et al. Evolution of a pathogen: a comparative genomics analysis identifies a genetic pathway to pathogenesis in Acinetobacter. PLoS One 2013; 8:e54287 [View Article] [PubMed]
     [Google Scholar]
  9. Nelson RE, Schweizer ML, Perencevich EN, Nelson SD, Khader K et al. Costs and mortality associated with multidrug-resistant healthcare-associated Acinetobacter infections. Infect Control Hosp Epidemiol 2016; 37:1212–1218 [View Article] [PubMed]
     [Google Scholar]
  10. Young LS, Sabel AL, Price CS. Epidemiologic, clinical, and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit. Infect Control Hosp Epidemiol 2007; 28:1247–1254 [View Article] [PubMed]
     [Google Scholar]
  11. Kadri SS, Adjemian J, Lai YL, Spaulding AB, Ricotta E et al. Difficult-to-treat resistance in Gram-negative Bacteremia at 173 US Hospitals: retrospective cohort analysis of prevalence, predictors, and outcome of resistance to all first-line agents. Clin Infect Dis 2018; 67:1803–1814 [View Article] [PubMed]
     [Google Scholar]
  12. Nelson RE, Slayton RB, Stevens VW, Jones MM, Khader K et al. Attributable mortality of healthcare-associated infections due to multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2017; 38:848–856 [View Article] [PubMed]
     [Google Scholar]
  13. Chuang Y-C, Sheng W-H, Li S-Y, Lin Y-C, Wang J-T et al. Influence of genospecies of Acinetobacter baumannii complex on clinical outcomes of patients with acinetobacter bacteremia. Clin Infect Dis 2011; 52:352–360 [View Article] [PubMed]
     [Google Scholar]
  14. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP et al. Nosocomial bloodstream infections in US Hospitals: analysis of 24,179 cases from a prospective nationwide surveillance Study. Clin Infect Dis 2004; 39:309–317 [View Article]
     [Google Scholar]
  15. Zhang Y, Xu G, Miao F, Huang W, Wang H et al. Insights into the epidemiology, risk factors, and clinical outcomes of carbapenem-resistant Acinetobacter baumannii infections in critically ill children. Front Public Health 2023; 11: [View Article]
     [Google Scholar]
  16. CDC Antibiotic resistance threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019 https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
  17. Kofteridis DP, Andrianaki AM, Maraki S, Mathioudaki A, Plataki M et al. Treatment pattern, prognostic factors, and outcome in patients with infection due to pan-drug-resistant gram-negative bacteria. Eur J Clin Microbiol Infect Dis 2020; 39:965–970 [View Article] [PubMed]
     [Google Scholar]
  18. Giamarellou H, Karaiskos I. Current and potential therapeutic options for infections caused by difficult-to-treat and pandrug resistant Gram-negative bacteria in critically ill patients. Antibiotics 2022; 11:1009 [View Article] [PubMed]
     [Google Scholar]
  19. Falagas ME, Rafailidis PI. Attributable mortality of Acinetobacter baumannii: no longer a controversial issue. Crit Care 2007; 11:134 [View Article] [PubMed]
     [Google Scholar]
  20. Nucleo E, Caltagirone M, Marchetti VM, D’Angelo R, Fogato E et al. Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria. Antimicrob Resist Infect Control 2018; 7:33 [View Article] [PubMed]
     [Google Scholar]
  21. Lee C-M, Lai C-C, Chiang H-T, Lu M-C, Wang L-F et al. Presence of multidrug-resistant organisms in the residents and environments of long-term care facilities in Taiwan. J Microbiol Immunol Infect 2017; 50:133–144 [View Article] [PubMed]
     [Google Scholar]
  22. Chen H, Au KM, Hsu KE, Lai CK, Myint J et al. Multidrug-resistant organism carriage among residents from residential care homes for the elderly in Hong Kong: a prevalence survey with stratified cluster sampling. Hong Kong Med J 2018; 24:350–360 [View Article] [PubMed]
     [Google Scholar]
  23. Munier A-L, Biard L, Rousseau C, Legrand M, Lafaurie M et al. Incidence, risk factors, and outcome of multidrug-resistant Acinetobacter baumannii acquisition during an outbreak in a burns unit. J Hosp Infect 2017; 97:226–233 [View Article] [PubMed]
     [Google Scholar]
  24. Huang P-Y, Shie S-S, Ye J-J, Lin S-P, Liu T-P et al. Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship. BMC Infect Dis 2017; 17:598 [View Article] [PubMed]
     [Google Scholar]
  25. Robustillo-Rodela A, Pérez-Blanco V, Espinel Ruiz MA, Ruiz Carrascoso G, Figueira Iglesias JC et al. Successful control of 2 simultaneous outbreaks of OXA-48 carbapenemase-producing Enterobacteriaceae and multidrug-resistant Acinetobacter baumannii in an intensive care unit. Am J Infect Control 2017; 45:1356–1362 [View Article] [PubMed]
     [Google Scholar]
  26. Gavaldà L, Soriano AM, Cámara J, Gasull R, Arch O et al. Control of endemic extensively drug-resistant Acinetobacter baumannii with a cohorting policy and cleaning procedures based on the 1 room, 1 wipe approach. Am J Infect Control 2016; 44:520–524 [View Article] [PubMed]
     [Google Scholar]
  27. Jajoo M, Manchanda V, Chaurasia S, Sankar MJ, Gautam H et al. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One 2018; 13:e0180705 [View Article] [PubMed]
     [Google Scholar]
  28. Maciel WG, da Silva KE, Croda J, Cayô R, Ramos AC et al. Clonal spread of carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. J Hosp Infect 2018; 98:300–304 [View Article] [PubMed]
     [Google Scholar]
  29. Ulu-Kilic A, Gundogdu A, Cevahir F, Kilic H, Gunes T et al. An outbreak of bloodstream infection due to extensively resistant Acinetobacter baumannii among neonates. Am J Infect Control 2018; 46:154–158 [View Article] [PubMed]
     [Google Scholar]
  30. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6:130 [View Article] [PubMed]
     [Google Scholar]
  31. Gaynes R, Edwards JR. National Nosocomial Infections Surveillance System Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005; 41:848–854 [View Article] [PubMed]
     [Google Scholar]
  32. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ et al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128:3854–3862 [View Article] [PubMed]
     [Google Scholar]
  33. Wroblewska MM, Dijkshoorn L, Marchel H, van den Barselaar M, Swoboda-Kopec E et al. Outbreak of nosocomial meningitis caused by Acinetobacter baumannii in neurosurgical patients. J Hosp Infect 2004; 57:300–307 [View Article] [PubMed]
     [Google Scholar]
  34. Simor AE, Lee M, Vearncombe M, Jones-Paul L, Barry C et al. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management. Infect Control Hosp Epidemiol 2002; 23:261–267 [View Article] [PubMed]
     [Google Scholar]
  35. Chopra T, Marchaim D, Awali RA, Krishna A, Johnson P et al. Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes. Antimicrob Agents Chemother 2013; 57:6270–6275 [View Article] [PubMed]
     [Google Scholar]
  36. Clinical and Laboratory Standards Institute Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard, 9th edn Wayne, PA: CLSI; 2012
     [Google Scholar]
  37. Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, 26th edn Wayne, PA: CLSI; 2016
     [Google Scholar]
  38. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters. Växjö, SE: EUCAST2016; 2024 http://www.eucast.org
  39. Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement, M100-S24 edn Wayne, PA: CLSI; 2014
     [Google Scholar]
  40. Papathanakos G, Andrianopoulos I, Papathanasiou A, Priavali E, Koulenti D et al. Colistin-resistant Acinetobacter Baumannii bacteremia: a serious threat for critically ill patients. Microorganisms 2020; 8:287 [View Article] [PubMed]
     [Google Scholar]
  41. Ng TM, Teng CB, Lye DC, Apisarnthanarak A. A multicenter case-case control study for risk factors and outcomes of extensively drug-resistant Acinetobacter baumannii bacteremia. Infect Control Hosp Epidemiol 2014; 35:49–55 [View Article] [PubMed]
     [Google Scholar]
  42. Fu Q, Ye H, Liu S. Risk factors for extensive drug-resistance and mortality in geriatric inpatients with bacteremia caused by Acinetobacter baumannii. Am J Infect Control 2015; 43:857–860 [View Article] [PubMed]
     [Google Scholar]
  43. Tseng Y-C, Wang J-T, Wu F-LL, Chen Y-C, Chie W-C et al. Prognosis of adult patients with bacteremia caused by extensively resistant Acinetobacter baumannii. Diagn Microbiol Infect Dis 2007; 59:181–190 [View Article] [PubMed]
     [Google Scholar]
  44. Batirel A, Balkan II, Karabay O, Agalar C, Akalin S et al. Comparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections. Eur J Clin Microbiol Infect Dis 2014; 33:1311–1322 [View Article]
     [Google Scholar]
  45. Freire MP, de Oliveira Garcia D, Garcia CP, Campagnari Bueno MF, Camargo CH et al. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia. Clin Microbiol Infect 2016; 22:352–358 [View Article] [PubMed]
     [Google Scholar]
  46. Wisplinghoff H, Edmond MB, Pfaller MA, Jones RN, Wenzel RP et al. Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clin Infect Dis 2000; 31:690–697 [View Article] [PubMed]
     [Google Scholar]
  47. Chen HP, Chen TL, Lai CH, Fung CP, Wong WW et al. Predictors of mortality in Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect 2005; 38:127–136 [PubMed]
     [Google Scholar]
  48. Cisneros JM, Reyes MJ, Pachón J, Becerril B, Caballero FJ et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996; 22:1026–1032 [View Article] [PubMed]
     [Google Scholar]
  49. Kao H-H, Peng C-K, Sheu C-C, Lin Y-C, Chan M-C et al. Mortality and ventilator dependence in critically ill patients with ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii. J Microbiol Immunol Infect 2023; 56:822–832 [View Article] [PubMed]
     [Google Scholar]
  50. Kharaba A, Algethamy H, Hussein M, Al-Hameed FM, Alghamdi A et al. Incidence, outcomes, and predictors of Acinetobacter infection in Saudi Arabian critical care units. J Crit Care 2021; 66:109–116 [View Article] [PubMed]
     [Google Scholar]
  51. Saeed NK, Kambal AM, El-Khizzi NA. Antimicrobial-resistant bacteria in a general intensive care unit in Saudi Arabia. Saudi Med J 2010; 31:1341–1349 [PubMed]
     [Google Scholar]
  52. Al-Obeid S, Jabri L, Al-Agamy M, Al-Omari A, Shibl A. Epidemiology of extensive drug resistant Acinetobacter baumannii (XDRAB) at Security Forces Hospital (SFH) in Kingdom of Saudi Arabia (KSA). J Chemother 2015; 27:156–162 [View Article] [PubMed]
     [Google Scholar]
  53. Aly M, Tayeb HT, Al Johani SM, Alyamani EJ, Aldughaishem F et al. Genetic diversity of OXA-51-like genes among multidrug-resistant Acinetobacter baumannii in Riyadh, Saudi Arabia. Eur J Clin Microbiol Infect Dis 2014; 33:1223–1228 [View Article] [PubMed]
     [Google Scholar]
  54. Koizumi Y, Sakanashi D, Ohno T, Yamada A, Shiota A et al. The clinical characteristics of Acinetobacter bacteremia differ among genomospecies: a hospital-based retrospective comparative analysis of genotypically identified strains. J Microbiol Immunol Infect 2019; 52:966–972 [View Article] [PubMed]
     [Google Scholar]
  55. Rangel K, Chagas TPG, De-Simone SG. Acinetobacter baumannii infections in times of COVID-19 pandemic. Pathogens 2021; 10:1006 [View Article] [PubMed]
     [Google Scholar]
  56. Cheng A, Chuang Y-C, Sun H-Y, Sheng W-H, Yang C-J et al. Excess mortality associated with colistin-tigecycline compared with colistin-carbapenem combination therapy for extensively drug-resistant Acinetobacter baumannii bacteremia: a multicenter prospective observational study. Crit Care Med 2015; 43:1194–1204 [View Article] [PubMed]
     [Google Scholar]
  57. Song JY, Cheong HJ, Choi WS, Heo JY, Noh JY et al. Clinical and microbiological characterization of carbapenem-resistant Acinetobacter baumannii bloodstream infections. J Med Microbiol 2011; 60:605–611 [View Article] [PubMed]
     [Google Scholar]
  58. Ballouz T, Aridi J, Afif C, Irani J, Lakis C et al. Risk factors, clinical presentation, and outcome of Acinetobacter baumannii bacteremia. Front Cell Infect Microbiol 2017; 7:156 [View Article] [PubMed]
     [Google Scholar]
  59. Al-Abdulkarim DA, Alzuwayed OA, Al Ammari M, Al Halwan S, Al Maklafi N et al. Colistin-induced Nephrotoxicity in a Tertiary Teaching Hospital. Saudi J Kidney Dis Transpl 2020; 31:1057–1061 [View Article] [PubMed]
     [Google Scholar]
  60. Gunay E, Kaya S, Baysal B, Yuksel E, Arac E. Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit. Ren Fail 2020; 42:704–709 [View Article] [PubMed]
     [Google Scholar]
  61. Arrayasillapatorn N, Promsen P, Kritmetapak K, Anunnatsiri S, Chotmongkol W et al. Colistin-induced acute kidney injury and the effect on survival in patients with multidrug-resistant Gram-negative infections: significance of drug doses adjusted to ideal body weight. Int J Nephrol 2021; 2021:7795096 [View Article] [PubMed]
     [Google Scholar]
  62. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D et al. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant Gram-negative infections. Clin Infect Dis 2023ciad428 [View Article] [PubMed]
     [Google Scholar]
/content/journal/acmi/10.1099/acmi.0.000826.v4
Loading
Retrospective analysis of Acinetobacter baumannii bacteraemia risk factors, complications and mortality in a tertiary university hospital in Saudi Arabia
Access Microbiology 6, 000826.v4 (2024); https://doi.org/10.1099/acmi.0.000826.v4
/content/journal/acmi/10.1099/acmi.0.000826.v4
/content/journal/acmi/10.1099/acmi.0.000826.v4
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error