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Abstract：
Carbapenem-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.
In 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.
Of 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.
CRAb 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.
In 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.
Of 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.
CRAb 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.
摘要：
背景：耐碳青霉烯鲍曼不动杆菌（CRAb）是最有问题的抗菌耐药细菌之一。我们试图阐明CRAb的国际流行病学和临床影响。
方法：在一项前瞻性观察性队列研究中，在2017年至2019年期间，在全球五个地区的46家医院招募了842名临床CRAb培养的住院患者。主要结果是指标培养后30天的全因死亡率。对菌株进行全基因组分析。
结果：842例，536（64％）代表感染。到30天,128名（24%）感染者死亡，从澳大利亚-新加坡的18个中的1个（6％）到美国的216个中的54个（25％）和中南美洲的49个中的24个（49％），而42（14％）的未感染患者死亡。与其他类型的感染相比，菌血症与更高的死亡风险相关(96例感染中的40[42%]440的88[20%]）。在多变量逻辑回归分析中，血流感染和较高的年龄校正Charlson合并症指数与30日死亡率独立相关.克隆第2组(CG2)菌株占主导地位，中南美洲除外，从美国369人中的216人(59%)到中国291人中的282人(97%)不等。获得的碳青霉烯酶基因由842个分离株中的769个（91％）携带。CG2菌株与较高水平的美罗培南抗性显著相关，然而,与CG2病例相比,非CG2病例的死亡比例过高.
结论：各地区的CRAb感染类型和临床结局差异显著。虽然CG2菌株仍然占优势，非CG2菌株与较高的死亡率相关.
背景：#NCT03646227。
方法：在一项前瞻性观察性队列研究中，在2017年至2019年期间，在全球五个地区的46家医院招募了842名临床CRAb培养的住院患者。主要结果是指标培养后30天的全因死亡率。对菌株进行全基因组分析。
结果：842例，536（64％）代表感染。到30天,128名（24%）感染者死亡，从澳大利亚-新加坡的18个中的1个（6％）到美国的216个中的54个（25％）和中南美洲的49个中的24个（49％），而42（14％）的未感染患者死亡。与其他类型的感染相比，菌血症与更高的死亡风险相关(96例感染中的40[42%]440的88[20%]）。在多变量逻辑回归分析中，血流感染和较高的年龄校正Charlson合并症指数与30日死亡率独立相关.克隆第2组(CG2)菌株占主导地位，中南美洲除外，从美国369人中的216人(59%)到中国291人中的282人(97%)不等。获得的碳青霉烯酶基因由842个分离株中的769个（91％）携带。CG2菌株与较高水平的美罗培南抗性显著相关，然而,与CG2病例相比,非CG2病例的死亡比例过高.
结论：各地区的CRAb感染类型和临床结局差异显著。虽然CG2菌株仍然占优势，非CG2菌株与较高的死亡率相关.
背景：#NCT03646227。
