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Objective To investigate the death prognosis and risk factors of extensively drug-resistant Acinetobacter baumannii in hospitalized elderly patients with hematological infection, so as to facilitate clinical prevention and treatment. Methods The elderly (> 80 years old) hospitalized patients with hematological infection in our hospital from 2015 to 2021 were selected for analysis. Firstly, 314 patients with extensively drug-resistant Acinetobacter baumannii hematological infection were distinguished by etiological analysis. A total of 98 cases of death were detected during hospitalization (later referred to as the observation group). By comparing with the surviving patients (216 cases) (later referred to as the control group), the general data of patients with XDRAB infection were collected, and the risk of death and its influencing factors were analyzed. Results In the study, the proportion of patients in the observation group who used catheters was higher, the catheter retention time was longer, the acute physiology and chronic health status II scores were higher, and the proportion of patients who lost self-care ability was also higher. Conclusion The death of blood borne infection of extensively drug-resistant Acinetobacter baumannii in elderly patients is affected by many factors. Among them, patients who use catheters for a long time, have poor self-care ability and lose self-care ability have a higher risk of death, which is worthy of clinical attention.
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OBJECTIVE: To retrospectively study the clinical efficacy and safety of sulbactam sodium in treatment of extensively drug resistant Acinetobacter baumannii(XDRAB) infection. METHODS: Collect cases of XDRAB infection treated with sulbactam Sodium in our hospital from January 2014 to January 2016. Basic information of patients, infection sites, therapeutic strategies, drug combination, clinical outcomes and adverse reactions were analyzed retrospectively. RESULTS: A total of 7 cases were collected, including 4 cases of pulmonary infection, 2 cases of intracranial infection, 1 case of abdominal infection, therapeutic strategies for sulbactam sodium-based combination therapy. The total mortality rate was 42.8%; 1 case showed adverse drug reactions may correlated with sulbactam sodium. CONCLUSION: Mortality associated with XDRAB infection is high, and the clinical outcome is associated with host factors, because this article included in the number of cases is less, so difficult to evaluate the effectiveness of sulbactam sodium. Sulbactam sodium can be associated with other antimicrobial drugs for the treatment of XDRAB infection and provided more choices.
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Objective To investigate the bacteriostatic effect of 4 kinds of traditional Chinese herbal medicine on extensively drug‐resistant A .baumannii(XDRAB) bacteriostatic effect ,find a new way for the clinical treatment of the XDRAB infection .Meth‐ods The minimal inhibitory concentrations(MICs) of scutellaria ,forsythia ,rhizoma coptidis ,honeysuckle were determined by using broth two‐fold dilution method .Results The mean values of MICs of scutellaria ,forsythia ,rhizoma coptidis ,honeysuckle were 30 .99 ,187 .50 ,27 .61 and 75 .00 mg/mL ,respectively .Among the 4 kinds of traditional Chinese herbal medicines ,rhizoma coptidis got the strongest antimicrobial effect strongest inhibitory effect .There was no significant difference in the inhibitory effect of the strains collected from local or nonlocal(P>0 .05) .Conclusion The 4 kinds of Chinese herbal medicine had in vitro antibacterial ac‐tivity to XDRAB in different degree.
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Objective To observe the clinical efficacy and adverse reactions of tigecycline in treatment of health-care-associated pneumonia (HAP ) caused by extensively drug-resistant Acinetobacter baumannii (XDRAB ). Methods Clinical data of patients who used tigecycline for the treatment of XDRAB HAP in intensive care units of a hospital from March 2013 to June 2014 were retrospectively analyzed.Results XDRAB isolated from 31 patients with HAP were all sensitive to tigecycline,the resistance rates to carbapenems and sulbactams (including cefopera-zone-sulbactam,SCF)were all 100%,17 cases (54.84%)were mixed infection.Combined use rates of tigecycline and SCF were 85.71 %(12/14)in respiratory intensive care unit(RICU)and 47.06%(8/17)in general intensive care unit(GICU).Of 31 patients,the cure rate,effective rate,bacterial clearance rate,and antimicrobial adverse reac-tion rate were 29.03%,45.16%,61 .29%,and 16.13% respectively,no serious adverse drug reactions occurred. In RICU group and GICU group,the cure rates were 42.86% and 17.65% respectively,effective rates were 71 .43% and 23.53% respectively,and bacterial clearance rates were 78.57 % and 47.06% respectively,difference in effective rate between two groups was significant (P <0.05).Among patients receiving combination of tigecycline and SCF as well as not receiving combined SCF,the cure rates were 35.00% and 18.18% respectively,effective rates were 60.00% and 18.18% respectively,and bacterial clearance rates were 65.00% and 54.55% respectively, difference in effective rate between two groups was significant (P <0.05).Conclusion Tigecycline has a good clini-cal efficacy and little adverse reaction in treating XDRAB HAP;tigecycline combined with SCF is a good choice.
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OBJECTIVE:To explore the role of clinical pharmacists in the treatment of pan-drug resistant Acinetobacter bau-mannii infection. METHODS:Clinical pharmacists participated in the treatment for a severe pneumonia case of pan-drug resistant A. baumannii infection. Clinical pharmacists supplied overall pharmaceutical care and suggestions with respects to initial medication scheme evaluation,pathogen judgment,therapy drug selection,ADR disposal,etc.,including anti-infective treatment of moxifloxa-cin 0.4 g,ivgtt,qd+meropenem 0.5 g,ivgtt,q8 h+linezolid 0.6 g,ivgtt,q12 h;anti-pan-drug resistant A. baumannii infection of cefoperazone sodium and sulbactam sodium 3.0 g,ivgtt,q8 h+tigecycline 50 mg,ivgtt,q12 h;liver protection of ademetionine 1, 4-Butanedisulfonate 1.0 g,ivgtt,qd+reduced glutathione 1.8 g,ivgtt,qd. RESULTS:After 25 d treatment,the patient hadn’t been fe-vered,and hemogram and hepatic function index decreased to normal value. CONCLUSIONS:Clinical pharmacist should be en-gage in anti-infective treatment and pharmaceutical care,and provide physicians reasonable medication suggestion so as to promote care rate in the clinic.
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Objective To describe the monitoring and control of pan-drug resistant Acinetobacter baumannii (XDRABA) colonization and infection in a medical intensive care unit (ICU),and to summarize the effective measures of surveillance of nosocomial infection and control.Methods Nonsurgical patients admitted to medical ICU of Peking University People's Hospital from September 2009 to April 2013 with length of ICU stay over 48 hours were surveyed.Number of cases of colonization and infection of XDRABA per month was recorded,and the clinical features of patients with XDRABA colonization and infection were observed.The control of XDRABA colonization and infection was divided into three stages:① Outbreak stage,from September 2009 to August 2010,the infection control measures included stringent hand hygiene and surface disinfection,use of disposable ventilator tubes and improvement in antibiotics use.② Environmental control stage,from September 2010 to April 2012,the infection control measures consisted of on-the-spot investigation,isolation of patients with XDRABA colonization and infection,tubes terminal environment disinfection.③ Microbial screening stage,from May 2012 to April 2013,throat,nose and axillary swabs were obtained when the patients admitted.Results From 2009 September to 2013 April there was a total of 193 patients colonized or infected with XDRABA,and 64 patients died (mortality rate was 33.2％),and 133 (68.9％) patients were on mechanical ventilation.Patients with XDRABA colonization and infection had severer illness [acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score 20.3 ±6.7],longer ICU stay [(34.6 ± 13.8) days].In outbreak stage,number of cases with XDRABA colonization and infection was 5-9 per month.In environmental control stage,case number of XDRABA colonization and infection was 3-6 per month.In microbial screening stage,case number of XDRABA colonization and infection,which were already present,was 2-4 per month,and they were mainly admitted from emergency department (59.5％).The number of cases of ICU acquired XDRABA colonization and infection decreased from 2-3 to 0-1 per month.Conclusion To control the colonization and infection of XDRABA,monitoring of microorganism,hand hygiene,isolation of patients with XDRABA colonization and infection,and stringent environment disinfection were very necessary.
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Objective To approach the clinical effect of cefoperazone sulbactam associated with tigecycline for treatment of patients with severe pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in intensive care unit(ICU). Methods Retrospectively,the treatments of 88 patients with sepsis and pulmonary infection caused by pan drug-resistant Acinetobacter baumannii admitted in ICU from January,2011 to June,2013 were analyzed,among them antibiotics were used for 82 patients,and the rest 6 patients did not use antibiotics because of family refusal or abandonment of therapy. The patients having used antibiotics were divided into three groups:A group(27 patients)received cefoperazone sulbactam,B group(30 patients)received cefoperazone sulbactam associated with amikacin,and C group(25 patients)received cefoperazone sulbactam associated with tigecycline, antimicrobial treatment being for 7-15 days. The venous blood was collected to determine the changes in white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)before and after therapy. The rate of bacteriological efficiency,successful weaning of mechanical instrument,28-day mortality rate and clinical efficacy were observed after therapy in three groups. Results Before therapy,the comparisons of levels of WBC,CRP and PCT among three groups were of no statistically significant difference(all P>0.05),and they were decreased obviously after therapy in three groups among which they were decreased most significantly in C group〔WBC(×109/L):17.01±5.35 vs. 20.40±6.54,18.28±6.41;CRP(mg/L):64.6±8.4 vs. 68.3±12.7,70.0±13.4;PCT(μg/L):20.84±7.26 vs. 36.14±10.12,52.66±13.47,P<0.05〕. The rates of bacteriological efficiency and successful weaning in C group were increased more significantly than those in either A or B groups after therapy(bacteriological efficiency:76.00%vs. 44.44%,46.67%,χ2=9.750,P=0.006;rate of successful weaning:72.00%vs. 40.74%, 43.33%,χ2=12.083,P=0.009),and 28-day mortality rate in C group was much lower than those in A and B groups (24.00% vs. 48.15%,36.67%,χ2=11.510,P=0.030). The total clinical efficiency in C group was much higher than those in A and B groups(76.00%vs. 44.44%,46.67%,both P<0.05). Conclusion Cefoperazone sulbactam associated with tigecycline has significant clinical therapeutic effect in patients with pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in ICU,as it can decrease inflammatory reaction,increase the rates of successful weaning and survival.
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Objective To evaluate the activity of antibiotics against pan-drug-resistant (PDR) Acinetobacter baumannii by combination antimicrobial susceptibility test in viro with epsilometric methods (Etest method) and microdilution checkerboard (CB method),and to detect a good correlation between timekill curve with the above mentioned two assays.Methods Thirty-one clinical isolates of PDR Acinetobacter baumannii were selected for mono and combination antimicrobial susceptibility test in vitro by E-test and CB method,then a comparison was conducted between the test results and the time-kill curve.Mono drugs involved tigecycline,colistin,imipenem and amikacin,and combinations involved two of drugs above,and three drugs involved imipenem/tigecycline,plus amikacin combination.Results Synergistic effect was detected in imipenem plus colistin and tigecycline plus imipenem combination.A high comparability was revealed between the E-test method with antimicrobial drugs added into the culture medium and the time-kill curves.Synergy in the combination of imipenem/tigecycline,plus amikacin was detected by the CB method and time-kill curves.Conclusion The results showed that the effect of specific combination of antibiotics against PDR Acinetobacter baumannii could be predicted by testing their synergistic effect with combination antimicrobial susceptibility test.
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Objective To evaluate the activities of 18 pairs of antimicrobials combinations against non - duplicate clinical isolates of multidrug resistant Acinetobacter baumannii (MDRAB) in vitro.Methods Collect isolates of Acinetobacter baumannii from different patients from October 2009 to May 2010,which were isolated in Clinical Laboratory Center of Beijing Friendship Hospital,Capital Medical University.Use broth microdilution method to detect MIC of mono-antimicrobial,and checkerboard broth microdilution method to detect combinatied MIC,and calculate fractional inhibitory concentration (FIC) index to determine drug combinations effects.When the performance of the same drug combinations conflicted,appropriate strains were selected for screening of drug-resistant mechanisms by polymerase chain reaction( PCR),including efflux pump genes.Results In tests in vitro,rifampicin and polymyxin B,imipenem and gentamicin,cefepime and levofloxacin showed synergy at high proportion,68.1％,45.5％,40.9％,respectively.Minocycline and rifampicin,ampicillin/sulbactam and tobramycin.Ceftazidime and ciprofloxacin showed additive effect at high proportion,81.8％,68.2％,68.2％,respectively.There were several combinations which appeared the opposite effects to tested strains.Strains No.19 corresponding reaction was synergy and No.21,No.26 corresponding reactions were antagonism.The three strains above were selected for screening resistant mechanisms.The difference is that genotypes of adeS were negative in No.19 and positive in No.21 and No.26.Conclusion Rifampicin and polymyxin B combination showed synergy against the MDRAB in vitro,which can be considered as the treatment choice for critical infections caused by MDRAB.Imipenem and gentamicin,cefepime and levofloxacin also showed synergy in vitro,but in some isolates showed antagonism.This phenomenon may be due to the gene adeS activated by certain antibiotics,and the activated adeS drived efflux pump express or overexpress,which made the drugs in bacterial cells pumped out,causing antagonistic effect.The individual differences in strains should be considered when clinic strain apply these two combinations above.
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OBJECTIVE To analyze multi-drug resistant Acinetobacter baumannii(ABA) outbreak of nosocomial infection in the respiratory intensive care unit(RICU),to explore effective measures for prevention and control.METHODS In RICU on April 3 to 30 2009,patients under mechanical ventilation in the respiratory tract with MDRABA were conductd epidemiological surveys.RESULTS On 27 consecutive days,six cases occurred in mechanical ventilation in patients with lower respiratory tract MDRABA infection,of which 5 patients were cured;6 cases of lower respiratory tract of patients in sputum specimens isolated the same resistance spectrum MDRABA.CONCLUSIONS Medical personnel lack the consciousness of washing their hands.Indoor environment,air disinfection machine lack of supervision in mechanical ventilation patients with lower respiratory tract MDRABA,were the main reasons of infection outbreak.Strict isolation of patients should be strengthened,full implementation of hand-washing compliance,education,conventional screening,early intervention to prevent outbreak of hospital infection.
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Acinetobacter species are non-fermentative Gram-negative coccobacilli and they have emerged as important nosocomial pathogens which are associated with the significant multidrug resistance in recent years. Carbapenem-resistant A. baumannii (CRAB) and pandrug-resistant A. baumannii (PDRAB) were reported in 1991 and 1998, respectively. Fiftyeight isolates of Acinetobacter species recovered from a university hospital between August 2004 and March 2005 were investigated for the existence of CRAB, PDRAB, extended-spectrum beta-lactamase (ESBL)-producing Acinetobacter and examined for their phenotypic and genotypic characteristics. Genomospecies of Acinetobacter species were determined by amplified rDNA restriction analysis (ARDRA) and antimicrobial susceptibility test was performed with 13 kinds of antimicrobial agents. Metallo-beta-lactamase (MBL) producers were screened by modified hodge test and confirmed by imipenem-EDTA disk synergy test. Detection of blaIMP-1, blaVIM-2, blaTEM, and blaPER-1 was performed by PCR. Genomic DNAs were analyzed by pulsed-field gel electrophoresis (PFGE). Among 58 isolates of Acinteobacter species, 40 isolates were identified as genospecies 2 (A. baumannii), 9 were 13TU, 5 were A. phenon 6/ct, and 4 were Acinetobacter genospecies 3 by ARDRA. Thirteen isolates were confirmed as MBL-producers and blaIMP-1 and blaVIM-2 were carried by 5 and 8 isolates of them, respectively. MBL-producers were mostly 13TU, A. phenon 6/ct 13TU, and Acinetobacter genospecies 3 and they were susceptible to ciprofloxacin and ampicillin-sulbactam. BlaPER-1 was carried by thirteen isolates and 12 isolates of them were PDRAB showing resistance to all antimicrobial agents tested, including ceftazidime, cefepime, aztreonam, ciprofloxacin, amikacin, gentamicin, ampicillin-sulbactam, and imipenem. In conclusion, most MBL-producers belonged to 13TU, A. phenon 6/ct 13TU, and Acinetobacter genospecies 3 which were susceptible to ciprofloxacin and ampicillin-sulbactam, whereas 12 of 13 PER-1-producers were PDRAB originated from the same clone.
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Acinetobacter , Amicacina , Anti-Infecciosos , Aztreonam , beta-Lactamases , Ceftazidima , Ciprofloxacina , Células Clonais , DNA , DNA Ribossômico , Resistência a Múltiplos Medicamentos , Eletroforese em Gel de Campo Pulsado , Gentamicinas , Imipenem , Reação em Cadeia da PolimeraseRESUMO
Acinetobacter species are non-fermentative Gram-negative coccobacilli and they have emerged as important nosocomial pathogens which are associated with the significant multidrug resistance in recent years. Carbapenem-resistant A. baumannii (CRAB) and pandrug-resistant A. baumannii (PDRAB) were reported in 1991 and 1998, respectively. Fiftyeight isolates of Acinetobacter species recovered from a university hospital between August 2004 and March 2005 were investigated for the existence of CRAB, PDRAB, extended-spectrum beta-lactamase (ESBL)-producing Acinetobacter and examined for their phenotypic and genotypic characteristics. Genomospecies of Acinetobacter species were determined by amplified rDNA restriction analysis (ARDRA) and antimicrobial susceptibility test was performed with 13 kinds of antimicrobial agents. Metallo-beta-lactamase (MBL) producers were screened by modified hodge test and confirmed by imipenem-EDTA disk synergy test. Detection of blaIMP-1, blaVIM-2, blaTEM, and blaPER-1 was performed by PCR. Genomic DNAs were analyzed by pulsed-field gel electrophoresis (PFGE). Among 58 isolates of Acinteobacter species, 40 isolates were identified as genospecies 2 (A. baumannii), 9 were 13TU, 5 were A. phenon 6/ct, and 4 were Acinetobacter genospecies 3 by ARDRA. Thirteen isolates were confirmed as MBL-producers and blaIMP-1 and blaVIM-2 were carried by 5 and 8 isolates of them, respectively. MBL-producers were mostly 13TU, A. phenon 6/ct 13TU, and Acinetobacter genospecies 3 and they were susceptible to ciprofloxacin and ampicillin-sulbactam. BlaPER-1 was carried by thirteen isolates and 12 isolates of them were PDRAB showing resistance to all antimicrobial agents tested, including ceftazidime, cefepime, aztreonam, ciprofloxacin, amikacin, gentamicin, ampicillin-sulbactam, and imipenem. In conclusion, most MBL-producers belonged to 13TU, A. phenon 6/ct 13TU, and Acinetobacter genospecies 3 which were susceptible to ciprofloxacin and ampicillin-sulbactam, whereas 12 of 13 PER-1-producers were PDRAB originated from the same clone.
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Acinetobacter , Amicacina , Anti-Infecciosos , Aztreonam , beta-Lactamases , Ceftazidima , Ciprofloxacina , Células Clonais , DNA , DNA Ribossômico , Resistência a Múltiplos Medicamentos , Eletroforese em Gel de Campo Pulsado , Gentamicinas , Imipenem , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: The hospital-acquired pneumonia is the most common nosocomial infection. Recently, the Acinetobacter baummannii infections are rapidly increasing, especially the frequency of Multi-drug resistant A. baumannii. Therefore we assessed clinical features and prognosis of patients in the ICU with Multi-drug resistant A. baumannii from the sputum culture using the Clinical Pulmonary Infection Score(CPIS). METHODS: The medical records of 43 patients with Multi-drug resistant A. baumannii from sputum culture who were suspected had clinically pneumonia and admitted to the ICU from January 2000 to July 2002 were retrospectively analyzed. RESULT: 19 patients were CPIS greater than 6 and 24 patients were CPIS less than or equal to 6. Mean age for the former was 71+/-11 years old, and the latter was 61+/-19 years old. The mean APACHE II score on admission and on sputum study was not different between two groups(17.4+/-5.7 vs 18.5+/-6.1, p=0.553, 20+/-6 vs 17+/-8, p=0.078). But the mortality rate was 73.7% for the former, and 16.7% for the latter(p<0.001). CONCLUSION: In ICU patients who had clinically suspected pneumonia with sputum culture positive for Multi-drug resistant A. baumannii, the mortality was significantly higher if CPIS was greater than 6.