Acinetobacter baumannii Infection Risk of Mortality Among Patients in Intensive Care Units, With the Potential Impact of Age and Gender on Illnesses and Comorbidities

Öz

Objectives: Acinetobacter baumannii is most prevalent in intensive care units (ICUs) and associated with a high mortality rate. Therefore, the objective of this study was to highlight the factors that contribute to raising mortality rates for A. baumannii in the ICU.                                                                                                                      

Methods: This study, which is retrospective descriptive in nature, was carried out at Training and Research Hospital. A. baumannii isolates from 26 patients have been included for this study. The analysis included clinical features, comorbidity factors, mortality rates, antibiotic resistance profiles, and distribution in the intensive care unit. IBM SPSS 26, produced by IBM Corporation (International Business Machines Corporation), was also used to evaluate relationships between the independent variables IVs (age/gender) and dependent variables DVs (diseases/comorbidities) of A. baumannii-infected patients.                                                                          

Results: The study indicated that 73% of the patients were over 60 years old, with 65.39% male and 34.61% female. A. baumannii cases were most commonly associated with respiratory tract infections (46.14%) and a significant prevalence of COVID-19 infection. Tracheal aspirates and sputum constituted the most common source for A. baumannii (65.38). A. baumannii was most common in the Pandemic Intensive Care Unit and Anaesthesia Intensive Care Unit, with percentages of 30.76% and 23.08%, respectively. Hypertension and diabetes mellitus were the most prevalent comorbidities. The majority of the isolates (77%) showed an intermediate response to tigecycline, whereas all A. baumannii isolates were sensitive to colistin. According to SPSS, gender (male/female) had a positive effect on ICU patients as a risk factor.                                                                                                                                             

Conclusion: Physicians can benefit from this realistic surveillance data in their decision-making processes for patients who may be particularly vulnerable to A. baumannii infections.   

Anahtar Kelimeler

• Acinetobacter baumannii
• intensive care infection
• intensive care unit

Yoğun Bakım Ünitelerindeki Hastalarda Acinetobacter Baumannii Enfeksiyonunun Ölüm Riski Üzerine Yaş, Cinsiyetin ve Eşlik Eden Hastalıkların Potansiyel Etkisi

Öz

Amaç: Acinetobacter baumannii, yoğun bakım ünitelerinde (YBÜ) en sık görülen ve yüksek ölüm oranıyla ilişkili bir bakteridir. Bu nedenle, bu çalışmanın amacı, YBÜ’de A. baumannii’ye bağlı ölüm oranlarını artıran faktörleri ortaya koymaktır.                                                              

Yöntem: Bu çalışma, retrospektif tanımlayıcı nitelikte olup, Eğitim ve Araştırma Hastanesi’nde gerçekleştirilmiştir. Çalışmaya 26 hastadan elde edilen A. baumannii izolatları dahil edilmiştir. Analiz, klinik özellikler, eşlik eden hastalık faktörleri, ölüm oranları, antibiyotik direnç profilleri ve yoğun bakım ünitesindeki dağılımı içermiştir. IBM tarafından üretilen IBM SPSS 26 programı, A. baumannii enfeksiyonu olan hastaların bağımsız değişkenleri (yaş/cinsiyet) ve bağımlı değişkenleri (hastalıklar/eşlik eden hastalıklar) arasındaki ilişkileri değerlendirmek için de kullanılmıştır.                                                                                

Bulgular: Çalışma, hastaların %73’ünün 60 yaş üstü olduğunu, %65,39’unun erkek ve %34,61’inin kadın olduğunu göstermiştir. A. baumannii vakaları en sık solunum yolu enfeksiyonlarıyla (%46,14) ve önemli bir COVID-19 enfeksiyonu prevalansıyla ilişkilendirilmiştir. Trakeal aspiratlar ve balgam, A. baumannii için en yaygın kaynak olmuştur (%65,38). A. baumannii, sırasıyla %30,76 ve %23,08 oranlarıyla Pandemi Yoğun Bakım Ünitesi ve Anestezi Yoğun Bakım Ünitesinde en sık görülmüştür. Hipertansiyon ve diyabet mellitus en yaygın eşlik eden hastalıklar olmuştur. İzolatların çoğunluğu (%77) tigesiklin ‘e orta düzeyde yanıt verirken, tüm A. baumannii izolatları kolistine duyarlıydı. SPSS’e göre, cinsiyet (erkek/kadın) risk faktörü olarak yoğun bakım hastaları üzerinde olumlu bir etkiye vardı.                                                                                       

Sonuç: Hekimler, A. baumannii enfeksiyonlarına karşı özellikle savunmasız olabilecek hastalar için karar verme süreçlerinde bu gerçekçi sürveyans verilerinden faydalanabilirler.     

Anahtar Kelimeler

• Acinetobacter baumannii
• yogun bakim enfeksiyonu
• yogun bakim unitesi

Kaynakça

1. Lee CM, Kim CJ, Kim SE, Park KH, Bae JY, Choi HJ, Jung Y, Lee SS, Choe PG, Park WB, Kim ES. Risk factors for early mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteraemia. Journal of Global Antimicrobial Resistance. 2022 Dec 1;31:45-51. https://doi.org/10.1016/j.jgar.2022. 08.010.
2. Vrancianu CO, Gheorghe I, Czobor IB, Chifiriuc MC. Antibiotic resistance profiles, molecular mechanisms and innovative treatment strategies of Acinetobacter baumannii. Microorganisms. 2020 Jun 21;8(6):935. https://doi.org/10. 3390/microorganisms8060935.
3. Gedefie A, Demsis W, Ashagrie M, Kassa Y, Tesfaye M, Tilahun M, Bisetegn H, Sahle Z. Acinetobacter baumannii biofilm formation and its role in disease pathogenesis: a review. Infection and drug resistance. 2021 Sep 10:3711-9. https://doi.org/10.2147/IDR.S332051.
4. Roy S, Chowdhury G, Mukhopadhyay AK, Dutta S, Basu S. Convergence of biofilm formation and antibiotic resistance in Acinetobacter baumannii infection. Frontiers in medicine. 2022 Mar 24;9:793615. https://doi.org/10.3389/ fmed.2022.793615.
5. Nguyen M, Joshi SG. Carbapenem resistance in Acinetobacter baumannii, and their importance in hospital‐acquired infections: a scientific review. Journal of applied microbiology. 2021 Dec 1;131(6):2715-38. https://doi.org/10.1111/jam. 15130.
6. Falcone M, Tiseo G, Nicastro M, Leonildi A, Vecchione A, Casella C, Forfori F, Malacarne P, Guarracino F, Barnini S, Menichetti F. Cefiderocol as rescue therapy for Acinetobacter baumannii and other carbapenem-resistant gram-negative infections in intensive care unit patients. Clinical Infectious Diseases. 2021 Jun 1;72(11):2021-4. https://doi.org/10.1093/cid/ciaa1410.
7. Ababneh Q, Abulaila S, Jaradat Z. Isolation of extensively drug resistant Acinetobacter baumannii from environmental surfaces inside intensive care units. American Journal of Infection Control. 2022 Feb 1;50(2):159-65. https://doi.org/10.1016/j. ajic.2021.09.001.
8. European Centre for Disease Prevention and Control & World Health Organization. Regional Ofce for Europe. Antimicrobial resistance surveillance in Europe 2022–2020 data. 2022. World Health Organization. Regional Ofce for Europe. https://apps.who.int/iris/handle/10665/351141. License: CC BY-NC-SA 3.0 IGO

9. Huang L, Tang J, Tian G, Tao H, Li Z. Risk factors, outcomes, and predictions of extensively drug-resistant Acinetobacter baumannii nosocomial infections in patients with nervous system diseases. Infection and Drug Resistance. 2023 Dec 31:7327-37. https://doi.org/10.2147/IDR.S439241.
10. Akman N, Özmen P, Türk M. Alterations in the Antimicrobial Resistance Profile of Acinetobacter baumannii Strains Isolated from Intensive Care Unit Patients: Five-Year Follow-up in Cappadocia. Microbes, Infection and Chemotherapy. 2024 Oct 14;4:e2235-. https://doi.org/10.54034/mic.e2235 .
11. Arslan K, Şahin AS. Clinical characteristics, antibiotic resistance profiles, and factors affecting mortality in patients isolated acinetobacter baumannii in intensive care unit: retrospective tertiary center analysis. Compr Med. 2024;16(1):51-7. https://doi.org/10.14744/cm.2023.57338.
12. Blanco N, Harris AD, Rock C, Johnson JK, Pineles L, Bonomo RA, Srinivasan A, Pettigrew MM, Thom KA. Risk factors and outcomes associated with multidrug-resistant Acinetobacter baumannii upon intensive care unit admission. Antimicrobial agents and chemotherapy. 2018 Jan;62(1):10-128. https://doi.org/10.1128/AAC .01631-17.
13. Karakoç E, Ayyıldız A, Yelken B. Antibiotic resistance of acinetobacter strains in our intensive care unit: a retrospective study. Acta Medica Nicomedia. 2023 Feb 2;6(1):60-4.https://doi.org/10.53446/actamednicomedia.1186190.
14. Bahçe YG, Acer Ö, Özüdoğru O. Evaluation of bacterial agents isolated from endotracheal aspirate cultures of Covid-19 general intensive care patients and their antibiotic resistance profiles compared to pre-pandemic conditions. Microbial pathogenesis. 2022 Mar 1;164:105409. https://doi.org/10.1016/j.micpath.2022.105409.
15. Boral J, Genç Z, Pınarlık F, Ekinci G, Kuskucu MA, İrkören P, Kapmaz M, Tekin S, Çakar N, Şentürk E, Yurdakul F. The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit. Scientific Reports. 2022 Dec 2;12(1):20808. https://doi.org/10.1038/s41598-022-25493-8 .
16. Kuzucu EA, ÇALIŞKAN E, DANSUK Z, ÇAĞATAY M, ERDEM G, TEKELİ A. Investigation of Colistin Resistance and Heteroresistance in Acinetobacter spp. Isolates from Various Clinical Specimens. Mediterranean Journal of Infection Microbes and Antimicrobials. 2022;11(1):42-42. https://doi.org/10.4274/mjima.galenos.2022.2022.42.
17. Ballouz T, Aridi J, Afif C, Irani J, Lakis C, Nasreddine R, Azar E. Risk factors, clinical presentation, and outcome of Acinetobacter baumannii bacteremia. Frontiers in cellular and infection microbiology. 2017 May 4;7:156. https://doi.org/10.3389/fcimb.2017.00156 .
18. Ferlicolak L, Altintas ND, Yoruk F. A retrospective analysis of carbapenem-resistant Acinetobacter baumannii infections in critically ill patients: Experience at a tertiary-care teaching hospital ICU. Journal of intensive medicine. 2024 Apr 25;4(02):181-6. https://doi.org/ 10.1016/j.jointm.2023.11.004.
19. Ghareeb AM, Raafat MM, Bazan NS, Samir R. Carbapenem-resistant Acinetobacter baumannii infections among diabetic and non-diabetic patients and possible effective combination treatments. Future Journal of Pharmaceutical Sciences. 2024 Jul 18;10(1):90. https://doi.org/10.1186/s43094-024-00661-x.
20. Leung CH, Liu CP. Diabetic status and the relationship of blood glucose to mortality in adults with carbapenem-resistant Acinetobacter baumannii complex bacteremia. Journal of Microbiology, Immunology and Infection. 2019 Aug 1;52(4):654-62. https://doi.org/ 10.1016/j.jmii.2018.06.005.
21. Abed AB, Korcan SE, Güngör S. Antibiotics profile map of clinical A. baumannii strains isolated from health institutions in Turkey: a database search study and analysis of publications from 2011 to 2022. Bulletin of the National Research Centre. 2023 Feb 6;47(1):15. https://doi.org/10.1186/s42269-023-00982-6.
22. Görgün S, Usanmaz M, Odabaşı H. A meta-analysis study on colistin resistance in Acinetobacter baumannii species in Turkey. World J Adv Res Rev. 2021;10(2):090-7.https://doi.org/10.30574/wjarr.2021.10.2.0180.
23. Ersayoğlu İ, Özenen GG, Cebeci K, Arı HF, Bal ZŞ, Aydemir SŞ, Karapınar B. Tigecycline Usage for Severe Infections in the Pediatric Intensive Care Unit. Journal of Pediatric Infectious Diseases. 2024 Sep;19(05):260-6. https://doi.org/10.1055/s-0044-1788342.
24. Aslan K, Kiliç Ö, Kiral E, Bozan G, Bör Ö, Dinleyici EÇ. Clinical and laboratory responses to tigecycline in children. Journal of Clinical Pharmacy and Therapeutics. 2022 Oct;47(10):1585-90. https://doi.org/10.1111/jcpt.13708.
25. Miao S, Zhang Y, Li B, Yuan X, Zuo J. Antibiotic intermediates and antibiotics synergistically promote the development of multiple antibiotic resistance in antibiotic production wastewater. Journal of Hazardous Materials. 2024 Nov 5;479:135601. https://doi.org/10.1016/j.jhazmat.2024.135601
26. Liu C, Liu J, Lu Q, Wang P, Zou Q. The mechanism of tigecycline resistance in Acinetobacter baumannii under sub-minimal inhibitory concentrations of tigecycline. International Journal of Molecular Sciences. 2024 Feb 2;25(3):1819. https://doi:10.3390/ijms25031819.
27. Kurihara MN, Sales RO, Silva KE, Silva GD, Mansano MC, Mahmoud FF, Simionatto S. High lethality rate of carbapenem-resistant Acinetobacter baumannii in Intensive Care Units of a Brazilian hospital: An epidemiologic surveillance study. Revista da Sociedade Brasileira de Medicina Tropical. 2022;55:e0529-2021. https://doi.org/10.1590/0037-8682-0529-2021 .
28. Merdji H, Long MT, Ostermann M, Herridge M, Myatra SN, De Rosa S, Metaxa V, Kotfis K, Robba C, De Jong A, Helms J. Sex and gender differences in intensive care medicine. Intensive care medicine. 2023 Oct;49(10):1155-67. https://doi.org/10.1007/s00134-023-07194-6.
29. Lat TI, McGraw MK, White HD. Gender differences in critical illness and critical care research. Clinics in chest medicine. 2021 Aug 2;42(3):543. https://doi.org/10.1016/j.ccm.2021.04.012.