Mortality attributable to pandrug-resistant Acinetobacter baumannii infection

What is it about?

This 4-year cohort study assessed the direct clinical impact of infection with pandrug-resistant Acinetobacter baumannii (PDRAB) by comparing patients infected with PDRAB (n=62 patients) to those colonized with PDRAB (n=29 patients) and by simultaneously examining the risks of in-hospital mortality and discharge alive by means of competing risks survival analysis. Our analysis estimated that 1 of every 3 patients infected by PDRAB die in the hospital because of the infection. For patients still alive in the hospital, PDRAB infection prolongs substantially the length of hospitalization. New effective antimicrobials would thus be expected to considerably reduce hospital mortality and length of stay of patients with PDRAB infection. However, currently available therapeutic options remain extremely limited and emphasis on understanding and preventing healthcare-associated transmission of PDRAB is ever more important.

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Why is it important?

Extensive antimicrobial resistance (AMR) is becoming a serious public health threat globally. Rather than presenting itself as a rapidly evolving pandemic, as does SARS-CoV-2, AMR is an endemic problem slowly increasing, perhaps under the radar of health authorities and policy makers, and depriving future generations of effective therapies if we cannot bring further spread of AMR to a halt. AMR occurs when microorganisms (such as bacteria, fungi, viruses, and parasites) change and develop defenses when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, and antimalarials). AMR occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process. Pan-drug resistant or pan-resistant (PDR) bacteria are resistant against all available antibiotics. Infections caused from PDR bacteria are extremely difficult to treat, if not impossible to treat, and are becoming a harsh reality that patients and their doctors confront more and more frequently in hospitals worldwide. In a recent systematic review of the medical literature (J Antimicrob Chemother 2020;75(2):271-282), we revealed increasing emergence and dissemination of PDR bacteria in at least 25 countries in five continents. PDR bacteria typically affect severely ill patients in intensive care, who are already facing increased risk of death in the hospital. Estimating the frequency of deaths attributable to PDR infections is challenging and confounded by the underlying high risk of mortality of affected patients. Thereby, the 'debate' about how antimicrobial resistance affects patient outcomes in the hospital is vivid. Our latest study (J Hosp Infect 2020; in press) provides direct evidence of the serious clinical impact that PDR pathogens cause in critically ill hospitalized patients. Our analysis reveals that 1 of every 3 patients infected with PDR Acinetobacter dies in the hospital because of the infection. For patients still alive in the hospital, the infection leads to prolongation of the length of hospitalization, which increases healthcare costs and the risk of transmission of PDRAB to other vulnerable patients.

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