TABLE 1.
Univariate comparison between patients with breakthrough Acinetobacter bacteremia during carbapenem therapy and nonbreakthrough Acinetobacter bacteremia caused by carbapenem-resistant strains
| Characteristica | Breakthrough carbapenem resistant (n = 87) | Nonbreakthrough carbapenem resistant (n = 265) | P value |
|---|---|---|---|
| Demographic characteristics | |||
| Age (median [IQR]) (yr) | 69 (53–80) | 72 (58–81) | 0.192 |
| Male sex | 51 (58.6) | 186 (70.2) | 0.062 |
| Recent ICU stay | 49 (56.3) | 124 (46.8) | 0.156 |
| Bacteremia acquired in ICU | 60 (69.0) | 120 (45.3) | <0.001 |
| Length of hospitalization before bacteremia (median [IQR]) (days) | 21 (13–34) | 22 (10–39) | 0.624 |
| Comorbid conditions | |||
| Alcoholism | 3 (3.4) | 13 (4.9) | 0.770 |
| Liver cirrhosis | 8 (9.2) | 44 (16.6) | 0.130 |
| Chronic obstructive pulmonary disease | 28 (32.2) | 48 (18.1) | 0.009 |
| Chronic kidney disease | 32 (36.8) | 101 (38.1) | 0.924 |
| Type 2 diabetes mellitus | 31 (35.6) | 97 (36.6) | 0.972 |
| Hypertension | 37 (42.5) | 108 (40.8) | 0.868 |
| Coronary artery disease | 14 (16.1) | 31 (11.7) | 0.379 |
| Congestive heart failure | 21 (24.1) | 50 (18.9) | 0.363 |
| Cerebrovascular accident | 18 (20.7) | 51 (19.2) | 0.890 |
| Collagen vascular disease | 3 (3.4) | 8 (3.0) | 0.737 |
| Immunosuppressant therapy | 11 (12.6) | 26 (9.8) | 0.585 |
| Solid tumor | 13 (14.9) | 71 (26.8) | 0.035 |
| Hematological malignancy | 8 (9.2) | 8 (3.0) | 0.032 |
| Chemotherapy | 7 (8.0) | 14 (5.3) | 0.494 |
| Neutropenia | 7 (8.0) | 11 (4.2) | 0.165 |
| Trauma | 4 (4.6) | 9 (3.4) | 0.743 |
| Burn | 1 (1.1) | 5 (1.9) | 1.000 |
| Recent surgery | 21 (24.1) | 57 (21.5) | 0.716 |
| Charlson comorbidity index (median [IQR]) | 4 (2–6) | 4 (2–6) | 0.919 |
| Invasive procedures | |||
| Arterial catheter | 40 (46.0) | 108 (40.8) | 0.465 |
| Central venous catheter | 49 (56.3) | 139 (52.5) | 0.614 |
| Ventilator use | 70 (80.5) | 163 (61.5) | 0.002 |
| Hemodialysis | 18 (20.7) | 58 (21.9) | 0.932 |
| Thoracic drain | 10 (11.5) | 18 (6.8) | 0.239 |
| Abdominal drain | 11 (12.6) | 25 (9.4) | 0.514 |
| Sources of bacteremia | |||
| Pneumonia | 42 (48.3) | 99 (37.4) | 0.094 |
| Catheter | 18 (20.7) | 46 (17.4) | 0.590 |
| Urinary tract infection | 1 (1.1) | 10 (3.8) | 0.305 |
| Intra-abdominal infection | 6 (6.9) | 16 (6.0) | 0.975 |
| Wound | 2 (2.3) | 11 (4.2) | 0.532 |
| Primary bacteremia | 18 (20.7) | 83 (31.3) | 0.077 |
| Antimicrobial therapy after bacteremia onset | |||
| Appropriate antimicrobial therapy | 32 (36.8) | 56 (21.1) | 0.005 |
| Effective regimensb | |||
| Colistin | 18 (56.3) | 43 (75.4) | 0.102 |
| Tigecycline | 12 (37.5) | 15 (26.3) | 0.389 |
| Fluoroquinolone | 7 (21.9) | 9 (15.8) | 0.667 |
| Sulbactam | 2 (6.3) | 4 (7.0) | 1.000 |
| Carbapenem + colistin | 16 (50.0) | 11 (19.3) | 0.005 |
| Carbapenem + tigecycline | 6 (18.8) | 2 (3.5) | 0.023 |
| Carbapenem + sulbactam | 2 (6.3) | 1 (1.8) | 0.293 |
| Colistin + tigecycline | 4 (12.5) | 12 (21.1) | 0.471 |
| Outcome | |||
| Shock | 29 (33.3) | 89 (33.6) | 1.000 |
| APACHE II score (median [IQR]) | 26 (19–32) | 24 (17–30) | 0.023 |
| 14-day mortality | 45 (51.7) | 99 (37.4) | 0.025 |
| 30-day mortality | 54 (62.1) | 132 (49.8) | 0.062 |
| Species causing bacteremia | |||
| A. baumannii | 52 (59.8) | 184 (69.4) | 0.125 |
| A. nosocomialis | 24 (27.6) | 66 (24.9) | 0.722 |
| A. pittii | 10 (11.5) | 8 (3.0) | 0.004 |
| A. soli | 0 (0.0) | 4 (1.5) | 0.576 |
| Microbiological characteristics of causative microorganisms | |||
| Nonsusceptibility to: | |||
| Amikacin | 46 (52.9) | 117 (44.2) | 0.196 |
| Ampicillin-sulbactam | 52 (59.8) | 192 (72.3) | 0.036 |
| Cefepime | 75 (86.2) | 246 (92.9) | 0.094 |
| Ceftazidime | 78 (89.7) | 250 (94.3) | 0.208 |
| Piperacillin-tazobactam | 83 (95.4) | 258 (97.4) | 0.475 |
| Ciprofloxacin | 67 (77.0) | 223 (84.2) | 0.176 |
| Levofloxacin | 70 (80.5) | 221 (83.4) | 0.642 |
| Colistin | 0 (0.0) | 6 (2.3) | 0.343 |
| Tigecycline | 31 (35.6) | 94 (35.5) | 1.000 |
| Isolates harboring ISAba1-blaOXA-51-like | 20 (23.0) | 38 (14.3) | 0.085 |
| A. baumannii isolates harboring ISAba1-blaOXA-51-like/total no. of isolates harboring ISAba1-blaOXA-51-like (%) | 18/52 (36.7) | 32/184 (17.4) | 0.013 |
| Isolates harboring ISAba1-blaOXA-23-like | 37 (42.5) | 168 (63.4) | 0.001 |
| A. baumannii isolates harboring ISAba1-blaOXA-23-like/total no. of isolates harboring ISAba1-blaOXA-23-like (%) | 21/52 (40.4) | 147/184 (79.9) | <0.001 |
| Isolates harboring IS1008 (or IS1006)-ΔISAba3-blaOXA-58-like | 6 (6.9) | 8 (3.0) | 0.120 |
| Isolates harboring blaOXA-24-like | 11 (12.6) | 16 (6.0) | 0.076 |
| Isolates harboring blaIMP-like | 5 (5.7) | 5 (1.9) | 0.072 |
| Isolates harboring blaVIM-like | 3 (3.4) | 5 (1.9) | 0.414 |
a
Data are presented as the number (%), unless otherwise indicated. IQR, interquartile range; ICU, intensive care unit; APACHE II, Acute Physiology and Chronic Health Evaluation II.
b
Each item denotes the corresponding antimicrobial agent alone or in combination with other antimicrobial agent(s). For example, “colistin” denotes “colistin alone or in combination with other antimicrobial agent(s).” The numbers in parentheses denote the percentage of patients who received the corresponding antimicrobial agent alone or in combination with other antimicrobial agent(s) among the patients who received appropriate antimicrobial therapy.