Comparison of Virulence Attributable to Different Levels of Antimicrobial Resistant Acinetobacter baumannii Bacteremia
Tharntip Sangsuwan MD¹, Ornanong Komet MNS², Wison Laochareonsuk MD¹, Silom Jamulitrat MD¹
Affiliation : ¹ Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand ² Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkla, Thailand
Objective : To determine the mortality rate and severity of sepsis in patients who have acquired drug resistant Acinetobacter baumannii (AB)
bacteremia (ABB).
Materials and Methods : Microbiology data and information of adult patients hospitalized at Songklanagarind Hospital with positive blood culture for AB between January 2008 and April 2017 were retrieved and reviewed. Antimicrobial resistance was classified into four categories comprising of non-multidrug-resistant (nMDR), multidrug-resistant (MDR), extensively-drug-resistant (XDR), and possible-pandrug-resistant (pPDR). The primary outcome of bacteremia was the in-hospital mortality rate, with the additional outcome, being severity of sepsis represented by the Sepsis Severity Score (SSS). The differences in mortality rates were assessed by Cox proportional hazard model. Results of analysis were reported in terms of hazard ratio (HR) and corresponding 95% confidence interval (CI). Comparison of SSS was evaluated by generalized linear model (GLM) and reported in term of odds ratio (OR).
Results : The present study identified 480 patients with hospital-acquired ABB. The proportions among resistance categories were 11%, 39%, 47%, and 3% with crude mortality rates of 20%, 34%, 69%, and 75% for nMDR, MDR, XDR, and pPDR, respectively. GLM analysis showed ORs for higher SSS score in the appropriate treated MDR, and XDR were 1.09 (1.01 to 1.19), and 1.12 (1.03 to 1.22), respectively. The inappropriate treatment ORs for nMDR, MDR, XDR, and pPDR were 1.17 (0.99 to 1.39), 1.30 (1.17 to 1.45), 1.17 (1.08 to 1.28), and 1.01 (0.87 to 1.17), respectively.
Conclusion : The virulence of AB was not reduced when its level of antibiotic resistance was upgraded.
Received 15 May 2020 | Revised 20 July 2020 | Accepted 24 July 2020
doi.org/10.35755/jmedassocthai.2021.05.10894
Keywords : Acinetobacter baumannii ; Drug resistance; Bacteremia; Mortality; Virulence
