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Clinical characteristics and outcomes of bacteremia due to different genomic species of Acinetobacter baumannii complex in patients with solid tumors

Infection volume 40, pages 19–26 (2012)Cite this article

Abstract

Purpose

Acinetobacter baumannii, Acinetobacter genomic species 3 (AGS 3), and Acinetobacter genomic species sensu Tjernberg and Ursing (AGS 13TU) are phenotypically indistinguishable and are often reported together as the A. baumannii complex (ABC). Few studies have investigated the difference in outcome caused by these different species, and all involved heterogeneous groups of patients. This study aimed to delineate whether there are differences in the clinical characteristics and outcome among patients with solid tumors and bacteremia caused by A. baumannii or two other non-baumannii ABC species (AGS 3 plus AGS 13TU).

Methods

Patients with solid tumors and ABC bacteremia over a period of 5 years in a medical center were identified. The patient data were retrospectively reviewed and analyzed.

Results

We identified 103 patients with ABC bacteremia during the study period. Bacteremia was due to A. baumannii in 30 patients, AGS 3 in 24 patients, and AGS 13TU in 49 patients. Among the 103 patients with ABC bacteremia, recent stay in the intensive care unit (ICU) (p = 0.008) was independently associated with the acquisition of A. baumannii bacteremia. Multivariate analysis revealed that bacteremia caused by A. baumannii (hazard ratio [HR] 2.990, 95% confidence interval [CI], 1.021–8.752, p = 0.046) and Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥21 (HR 4.623, 95% CI 1.348–15.859, p = 0.015) were independent factors associated with 14-day mortality.

Conclusions

Infection with A. baumannii and a high APACHE II score (≥21) might be associated with poor outcome in patients with solid tumors and ABC bacteremia.

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References

  1. Jung JY, Park MS, Kim SE, Park BH, Son JY, Kim EY, Lim JE, Lee SK, Lee SH, Lee KJ, Kang YA, Kim SK, Chang J, Kim YS. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis. 2010;10:228.

    PubMed  Article  Google Scholar 

  2. Velasco E, Byington R, Martins CS, Schirmer M, Dias LC, Gonçalves VM. Bloodstream infection surveillance in a cancer centre: a prospective look at clinical microbiology aspects. Clin Microbiol Infect. 2004;10:542–9.

    PubMed  Article  CAS  Google Scholar 

  3. Fagon JY, Chastre J, Domart Y, Trouillet JL, Gibert C. Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a protected specimen brush. Clin Infect Dis. 1996;23:538–42.

    PubMed  Article  CAS  Google Scholar 

  4. Beck-Sagué CM, Jarvis WR, Brook JH, Culver DH, Potts A, Gay E, Shotts BW, Hill B, Anderson RL, Weinstein MP. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol. 1990;132:723–33.

    PubMed  Google Scholar 

  5. Villers D, Espaze E, Coste-Burel M, Giauffret F, Ninin E, Nicolas F, Richet H. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med. 1998;129:182–9.

    PubMed  CAS  Google Scholar 

  6. Chen HP, Chen TL, Lai CH, Fung CP, Wong WW, Yu KW, Liu CY. Predictors of mortality in Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect. 2005;38:127–36.

    PubMed  Google Scholar 

  7. Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, Rosenzweig R, Gutmann L, Safar M, Acar J. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis. 1995;20:790–6.

    PubMed  Article  CAS  Google Scholar 

  8. Towner KJ. Acinetobacter: an old friend, but a new enemy. J Hosp Infect. 2009;73:355–63.

    PubMed  Article  CAS  Google Scholar 

  9. Lee NY, Chang TC, Wu CJ, Chang CM, Lee HC, Chen PL, Lee CC, Ko NY, Ko WC. Clinical manifestations, antimicrobial therapy, and prognostic factors of monomicrobial Acinetobacter baumannii complex bacteremia. J Infect. 2010;61:219–27.

    PubMed  Article  Google Scholar 

  10. Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol. 2007;5:939–51.

    PubMed  Article  CAS  Google Scholar 

  11. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev. 2008;21:538–82.

    PubMed  Article  CAS  Google Scholar 

  12. Lee YT, Huang LY, Chiang DH, Chen CP, Chen TL, Wang FD, Fung CP, Siu LK, Cho WL. Differences in phenotypic and genotypic characteristics among imipenem-non-susceptible Acinetobacter isolates belonging to different genomic species in Taiwan. Int J Antimicrob Agents. 2009;34:580–4.

    PubMed  Article  CAS  Google Scholar 

  13. Joly-Guillou ML. Clinical impact and pathogenicity of Acinetobacter. Clin Microbiol Infect. 2005;11:868–73.

    PubMed  Article  Google Scholar 

  14. Lim YM, Shin KS, Kim J. Distinct antimicrobial resistance patterns and antimicrobial resistance-harboring genes according to genomic species of Acinetobacter isolates. J Clin Microbiol. 2007;45:902–5.

    PubMed  Article  CAS  Google Scholar 

  15. Lin YC, Sheng WH, Chen YC, Chang SC, Hsia KC, Li SY. Differences in carbapenem resistance genes among Acinetobacter baumannii, Acinetobacter genospecies 3 and Acinetobacter genospecies 13TU in Taiwan. Int J Antimicrob Agents. 2010;35:439–43.

    PubMed  Article  CAS  Google Scholar 

  16. Lee JH, Choi CH, Kang HY, Lee JY, Kim J, Lee YC, Seol SY, Cho DT, Kim KW, Song do Y, Lee JC. Differences in phenotypic and genotypic traits against antimicrobial agents between Acinetobacter baumannii and Acinetobacter genomic species 13TU. J Antimicrob Chemother. 2007;59:633–9.

    PubMed  Article  CAS  Google Scholar 

  17. Houang ET, Chu YW, Chu KY, Ng KC, Leung CM, Cheng AF. Significance of genomic DNA group delineation in comparative studies of antimicrobial susceptibility of Acinetobacter spp. Antimicrob Agents Chemother. 2003;47:1472–5.

    PubMed  Article  CAS  Google Scholar 

  18. van den Broek PJ, Arends J, Bernards AT, De Brauwer E, Mascini EM, van der Reijden TJ, Spanjaard L, Thewessen EA, van der Zee A, van Zeijl JH, Dijkshoorn L. Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999–2001. Clin Microbiol Infect. 2006;12:837–43.

    PubMed  Article  Google Scholar 

  19. Wisplinghoff H, Edmond MB, Pfaller MA, Jones RN, Wenzel RP, Seifert H. Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility. Clin Infect Dis. 2000;31:690–7.

    PubMed  Article  CAS  Google Scholar 

  20. Chen TL, Siu LK, Wu RC, Shaio MF, Huang LY, Fung CP, Lee CM, Cho WL. Comparison of one-tube multiplex PCR, automated ribotyping and intergenic spacer (ITS) sequencing for rapid identification of Acinetobacter baumannii. Clin Microbiol Infect. 2007;13:801–6.

    PubMed  Article  CAS  Google Scholar 

  21. Chang HC, Wei YF, Dijkshoorn L, Vaneechoutte M, Tang CT, Chang TC. Species-level identification of isolates of the Acinetobacter calcoaceticus–Acinetobacter baumannii complex by sequence analysis of the 16S–23S rRNA gene spacer region. J Clin Microbiol. 2005;43:1632–9.

    PubMed  Article  CAS  Google Scholar 

  22. Huang LY, Chen TL, Lu PL, Tsai CA, Cho WL, Chang FY, Fung CP, Siu LK. Dissemination of multidrug-resistant, class 1 integron-carrying Acinetobacter baumannii isolates in Taiwan. Clin Microbiol Infect. 2008;14:1010–9.

    PubMed  Article  CAS  Google Scholar 

  23. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: M100-S20. Wayne, PA: CLSI;2010.

  24. Chiang DH, Wang CC, Kuo HY, Chen HP, Chen TL, Wang FD, Cho WL, Liu CY. Risk factors for mortality in patients with Acinetobacter baumannii bloodstream infection with genotypic species identification. J Microbiol Immunol Infect. 2008;41:397–402.

    PubMed  CAS  Google Scholar 

  25. Paterson DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis. 2006;43:S43–8.

    PubMed  Article  Google Scholar 

  26. Gkrania-Klotsas E, Hershow RC. Colonization or infection with multidrug-resistant Acinetobacter baumannii may be an independent risk factor for increased mortality. Clin Infect Dis. 2006;43:1224–5.

    PubMed  Article  Google Scholar 

  27. García-Garmendía JL, Ortiz-Leyba C, Garnacho-Montero J, Jiménez-Jiménez FJ, Monterrubio-Villar J, Gili-Miner M. Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med. 1999;27:1794–9.

    PubMed  Article  Google Scholar 

  28. Cisneros JM, Reyes MJ, Pachón J, Becerril B, Caballero FJ, García-Garmendía JL, Ortiz C, Cobacho AR. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis. 1996;22:1026–32.

    PubMed  Article  CAS  Google Scholar 

  29. Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med. 2003;29:471–5.

    PubMed  Google Scholar 

  30. Garnacho J, Sole-Violan J, Sa-Borges M, Diaz E, Rello J. Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: a matched cohort study. Crit Care Med. 2003;31:2478–82.

    PubMed  Article  Google Scholar 

  31. Albrecht MC, Griffith ME, Murray CK, Chung KK, Horvath EE, Ward JA, Hospenthal DR, Holcomb JB, Wolf SE. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll Surg. 2006;203:546–50.

    PubMed  Article  Google Scholar 

  32. Falagas ME, Kopterides P, Siempos II. Attributable mortality of Acinetobacter baumannii infection among critically ill patients. Clin Infect Dis 2006;43:389; author reply 389–90.

    PubMed  Article  Google Scholar 

  33. Bergogne-Bérézin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev. 1996;9:148–65.

    PubMed  Google Scholar 

  34. Munoz-Price LS, Weinstein RA. Acinetobacter infection. N Engl J Med. 2008;358:1271–81.

    PubMed  Article  CAS  Google Scholar 

  35. Boo TW, Walsh F, Crowley B. Molecular characterization of carbapenem-resistant Acinetobacter species in an Irish university hospital: predominance of Acinetobacter genomic species 3. J Med Microbiol. 2009;58:209–16.

    PubMed  Article  CAS  Google Scholar 

  36. Liang-Yu C, Kuo SC, Liu CY, Luo BS, Huang LJ, Lee YT, Chen CP, Chen TL, Fung CP. Difference in imipenem, meropenem, sulbactam, and colistin nonsusceptibility trends among three phenotypically undifferentiated Acinetobacter baumannii complex in a medical center in Taiwan, 1997–2007. J Microbiol Immunol Infect. 2011;Epub ahead of print.

  37. Erbay A, Idil A, Gözel MG, Mumcuoğlu I, Balaban N. Impact of early appropriate antimicrobial therapy on survival in Acinetobacter baumannii bloodstream infections. Int J Antimicrob Agents. 2009;34:575–9.

    PubMed  Article  CAS  Google Scholar 

  38. Chen CH, Lin LC, Chang YJ, Huang CC, Liu CE, Young TG. Analysis of prognostic factors in 95 patients with Acinetobacter baumannii bacteremia. Infection. 2003;31:331–5.

    PubMed  Google Scholar 

  39. Gordon NC, Wareham DW. Multidrug-resistant Acinetobacter baumannii: mechanisms of virulence and resistance. Int J Antimicrob Agents. 2010;35:219–26.

    PubMed  Article  CAS  Google Scholar 

  40. Eveillard M, Soltner C, Kempf M, Saint-André JP, Lemarié C, Randrianarivelo C, Seifert H, Wolff M, Joly-Guillou ML. The virulence variability of different Acinetobacter baumannii strains in experimental pneumonia. J Infect. 2009;60:154–61.

    PubMed  Article  Google Scholar 

  41. Routsi C, Pratikaki M, Platsouka E, Sotiropoulou C, Nanas S, Markaki V, Vrettou C, Paniara O, Giamarellou H, Roussos C. Carbapenem-resistant versus carbapenem-susceptible Acinetobacter baumannii bacteremia in a Greek intensive care unit: risk factors, clinical features and outcomes. Infection. 2010;38:173–80.

    PubMed  Article  CAS  Google Scholar 

  42. Martins AF, Kuchenbecker R, Sukiennik T, Boff R, Reiter KC, Lutz L, Machado AB, Barth AL. Carbapenem-resistant Acinetobacter baumannii producing the OXA-23 enzyme: dissemination in Southern Brazil. Infection. 2009;37:474–6.

    PubMed  Article  CAS  Google Scholar 

  43. Wadl M, Heckenbach K, Noll I, Ziesing S, Pfister W, Beer J, Schubert S, Eckmanns T. Increasing occurrence of multidrug-resistance in Acinetobacter baumannii isolates from four German University Hospitals, 2002–2006. Infection. 2010;38:47–51.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

This work was supported by grants from the Taipei Veterans General Hospital (VGH99C1-014 and V99S5-006) and the National Science Council, Taiwan (NSC98-2314-B-010-010-MY3).

Conflict of interest

There was no conflict of interest with any commercial company.

Author information

Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan

    M.-C. Chiang, S.-C. Kuo, S.-J. Chen, S.-P. Yang, T.-L. Chen & C.-P. Fung

  2. Immunology Research Center, Taipei Veterans General Hospital, Taipei, Taiwan

    T.-L. Chen

  3. Department of Medicine, Chutung Veterans Hospital, Chutung, Taiwan

    Y.-T. Lee

  4. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    S.-C. Kuo, Y.-T. Lee, T.-L. Chen & C.-P. Fung

Authors
  1. M.-C. Chiang
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  2. S.-C. Kuo
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  3. S.-J. Chen
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  4. S.-P. Yang
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  5. Y.-T. Lee
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  6. T.-L. Chen
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  7. C.-P. Fung
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Correspondence to T.-L. Chen.

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Chiang, MC., Kuo, SC., Chen, SJ. et al. Clinical characteristics and outcomes of bacteremia due to different genomic species of Acinetobacter baumannii complex in patients with solid tumors. Infection 40, 19–26 (2012). https://doi.org/10.1007/s15010-011-0187-4

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  • DOI: https://doi.org/10.1007/s15010-011-0187-4

Keywords

  • Acinetobacter baumannii complex (ABC)
  • Bacteremia
  • Solid tumor
  • Outcome
  • Genomic species