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Acinetobacter Baumannii Int J Clin Exp Med 2019;12(4):4330-4338 www.ijcem.com /ISSN:1940-5901/IJCEM0079462 Original Article Differences in clinical characteristics of bloodstream infections caused by Escherichia coli and Acinetobacter baumannii Xinrong Niu, Xiaohui Shi, Qifeng Li Department of Critical Care Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China Received November 21, 2017; Accepted November 9, 2018; Epub April 15, 2019; Published April 30, 2019 Abstract: Background: Bloodstream infections (BSI) caused by Escherichia coli (E. coli) and Acinetobacter bauman- nii (A. baumannii) are on the rise, accompanied by high morbidity and mortality. The aim of this study was to inves- tigate the differences between BSI caused by E. coli and A. baumannii. Methods: This was a retrospective study. A total of 118 patients were enrolled, including 63 cases of BSIs caused by E. coli and 55 cases of BSIs caused by A. baumannii. Clinical data were collected. Sources of infection, risk factors, drug resistance, mortality, and clinical characteristics were compared. Results: Sources of infection, including the pancreatic duct, lungs, urinary tract, and other sites between BSIs caused by E. coli and A. baumannii, showed statistical significance. Risk factors, includ- ing multiple infections, ICU acquired infections, time to blood culture positivity, antibiotic treatment, and antifungal treatment, between the two groups showed statistical differences. Treatment outcomes, including empiric antibiotic treatment, total hospital stay, in-hospital mortality, attributable 28-day mortality, and attributable in-hospital mortal- ity, between the two groups were statistically different. Resistance of E. coli to carbapenems was low and resistance of A. baumannii to prostacyclin was low. ICU acquired infections, time to blood culture positivity, acute kidney dam- age, renal replacement therapy, mechanical ventilation, and SOFA scores were statistically different between death and survival groups. Conclusion: BSIs caused by E. coli and A. baumanii showed significant differences in sources of infection, 28 days of mortality, time to blood culture positivity, and antibiotic resistance. Keywords: Bloodstream infections, Escherichia coli, Acinetobacter baumannii Introduction gen, is a gram-negative non-fermentative bac- terium that widely distributes in the natural In recent years, Enterobacteriaceae infections environment. A. baumannii can survive for a have increased, becoming the main source of long time in a hospital environment. It invades nosocomial infections. Escherichia coli (E. coli) the skin, respiratory tract, digestive tract, and and Klebsiella pneumoniae are the most com- urogenital tract, leading to a variety of serious mon pathogens of nosocomial infections [1, 2]. infections in patients with severely impaired E. coli belongs to the normal flora in human immune function, such as patients with ventila- body. When the body defense system weakens, tor-associated pneumonia, BSIs, urinary tract E. coli shows pathogenicity and becomes a con- infections, and meningitis [5-8]. A. baumannii ditional pathogen. The Chinese bacterial resis- also has a strong drug resistance. Multi-drug tance surveillance network [3] revealed that E. resistance, pan-resistant, and all-resistant A. coli became the most important bacterium baumannii are prevalent in the world [8]. A. causing bloodstream infections (BSI) during the baumannii-BSI often occurs in critically ill pa- period of 2011-2012. E. coli has become a rep- tients, seriously threatening lives [9]. resentative strain producing extended spec- trum beta-lactamases (ESBLs) [4]. E. coli has a Incidence of BSI is increasing all over the world, high resistance and can induce severe BSI with accompanied by higher fatality rates and mor- poor prognosis, presenting a great challenge to tality rates [10]. Each year, 80 to 257 infections clinical diagnosis and treatment. Acinetobacter in 100 thousand people are reported [11-18]. In baumannii (A. baumannii), a conditional patho- Europe, incidence and mortality of BSIs are Clinical characteristics of bloodstream infections estimated at 1,200,000 and 157,000, respec- pected infections, previous medical exposure tively [10]. Incidence and mortality of hospital (over 48 hours of antibiotic treatment, espe- acquired BSIs are 240,000 and 29,000, cially antifungal treatment over the past 30 respectively [10]. Therefore, early and effective days), and infections in other sites besides the targeted treatment for BSI is needed. According bloodstream. General conditions of the patients to clinical data, BSIs caused by E. coli and A. with BSI were evaluated, including acute renal baumannii are on the rise [19]. However, wheth- impairment, septic shock, mechanical ventila- er there are differences in clinical characteris- tion, renal replacement therapy, and removal of tics between the two has not been reported. suspicious foci of infections. Severity of dis- ease was assessed using APACHE II scores and In this study, risk factors of BSI, clinical fea- SOFA scores [20, 21]. Original and attributable tures of 28-day mortality, and differences in mortality, 28 day mortality, total hospital stay, clinical characteristics between BSIs caused by and hospital stay after BSI were assessed. E. coli and A. baumannii were analyzed. Present findings may provide clues and direction for Definitions clinical treatment of BSIs. Intensive care unit (ICU) acquired BSI was Materials and methods defined as the first positive blood culture deter- mined more than 2 days after admission to ICU. Patients Possible sources of infection were identified by microbiological results and analysis of 2 physi- This was a retrospective study. A total of 118 cians. Appropriate empiric antimicrobial thera- patients, including 87 males and 31 females, py refers to the management of the in vitro anti- with an average age of 52 ± 10.66, ranging microbial activity of the strain within 24 hours from 25 to 78 years old, were collected, be- after onset of BSI [16]. Septic shock was tween January 2007 and January 2014, from defined as sepsis associated with organ dys- the People’s Hospital of Xinjiang Uygur Au- function and persistent hypotension after vol- tonomous Region in Xinjiang China. There were ume resuscitation. Established criteria were 63 cases of BSIs caused by E. coli and 55 used to define acute kidney injury [21, 22]. cases of BSIs caused by A. baumannii. Inclusion Original mortality was defined as death after criteria were as follows: 1) At more than 48 the first positive blood culture of E. coli or A. hours after admission, patients had body tem- baumannii. Attributable mortality was defined peratures of more than 38°C or less than 36°C; by clinical evidence of active infections and 2) Patients had clinical manifestations, such as positive cultures or death due to organ failure chills or hypotension; and 3) E. coli or A. bau- during development or exacerbation of infec- mannii was isolated from blood cultures of the tions [23]. patients more than one time. Exclusion criteria were as follows: 1) Patients had no obvious Antimicrobial resistance fever or the fever could be explained by other reasons; and 2) Only one time was the blood Isolation, identification, and sensitivity monitor- culture positive, with the following blood cul- ing of microbiology were performed using the tures negative or found with other pathogens. Vitek 2 automatic system (Meriere, France). Informed consent was obtained from every Double-disc confirmation testing was used to + patient. The study was approved by the Ethics detect ESBL . E. coli ATCC 25922 and A. bau- Review Board of the People’s Hospital of mannii ATCC 19606 were used as controls. K-B Xinjiang Uygur Autonomous Region. agar diffusion method was used to test resis- tance of ampicillin, ampicillin/sulbactam, piper- Data collection acillin/tazobactam, cefoperazone/sulbactam, cefazolin, aztreonam, ceftazidime, ceftazidime, Clinical features of patients were analyzed and meropenem, imipenem, tigecycline, gentami- compared, including demography (gender, age), cin, ciprofloxacin Star, levofloxacin (LAX), and comorbidities (diabetes, chronic renal failure, compound sulfamethoxazole. The minimum biliary tract disease, congestive heart failure, inhibitory concentration was classified accord- and chronic obstructive pulmonary disease), ing to cut-off points established by the clinical results of time to blood culture positivity, sus- and laboratory bodies (CLSI2014) [24]. 4331 Int J Clin Exp Med 2019;12(4):4330-4338 Clinical characteristics of bloodstream infections Table 1. Sources of infection in the two groups (n, %) P<0.01), intra-abdomina (11.1% and E. coli A. baumannii 21.9%, P<0.01), catheter-related infec- Source of bacteremia P (n=63) (n=55) tion sites (3.2% and 14.5%, P<0.01), and skin or soft tissue (1.6% and Pancreaticobiliary tract 1 (19.0) 17 (30.9) 0.042* 5.5%, P<0.05). Surgical wounds, gastro- Pneumonia 8 (12.7) 20 (36.4) <0.001** intestinal tract, liver abscess, and un- Urinary tract 13 (20.6) 4 (7.3) 0.001** known sites showed no significant sta- Intra-abdomina 7 (11.1) 12 (21.9) 0.008** tistically significant differences betw- Catheter-related infection 2 (3.2) 8 (14.5) <0.001** een the two groups. Surgical wound 3 (4.8) 3 (5.5) 0.871 Comparison of risk factors associated Gastrointestinal tract 3 (4.8) 2 (3.6) 0.811 with progression of BSIs caused by E. Liver abscess 3 (4.8) 2 (3.6) 0.811 coli and A. baumannii Skin or soft tissue 1 (1.6) 3 (5.5) 0.015* Unknown 5 (7.9) 3 (5.5) 0.445 As shown in Table 2, there were statisti- Note: * and **, P<0.05 and <0.01, respectively. cally significant differences in multiple- infections, ICU acquired infections, ra- tes of diabetes, time to blood culture po- Statistical analysis sitivity, antibiotics, and antifungal therapy between BSIs caused by E. coli and A. bau- Data was analyzed using IBM SPSS 17.0 soft- mannii. In general, rates of multiple-infec- ware. Quantitative variables of normal and tions in BSIs caused by E. coli and A. bau- abnormal distribution are expressed as mean ± mannii were 6.3% and 18.2%, respectively.
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