Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

Georgios Papathanakos; Ioannis Andrianopoulos; Athanasios Papathanasiou; Efthalia Priavali; Despoina Koulenti; Vasilios Koulouras

doi:10.3390/microorganisms8020287

Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

Microorganisms. 2020 Feb 20;8(2):287. doi: 10.3390/microorganisms8020287.

Authors

Georgios Papathanakos¹, Ioannis Andrianopoulos¹, Athanasios Papathanasiou¹, Efthalia Priavali², Despoina Koulenti^{3

4}, Vasilios Koulouras¹

Affiliations

¹ University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece.
² Department of Microbiology, Medical School, University of Ioannina, 45110, Ioannina, Greece.
³ Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Herston Campus, Brisbane QLD 4029, Australia.
⁴ 2nd Critical Care Department, Attikon University Hospital, Rimini Street, 12463, Athens, Greece.

Abstract

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

Keywords: XDR; acinetobacter baumannii; bacteremia; blood stream infection; colistin resistance; fulminant septic shock; intensive care unit; mortality; sepsis.