Treatment strategies and mortality risk factors in patients with multidrug-resistant Acinetobacter baumannii pneumonia: A retrospective analysis.

Estrategias de tratamiento y factores de riesgo de mortalidad en pacientes con neumonía por Acinetobacter baumannii multirresistente: Un análisis retrospectivo.

• Lili Liu Infection Control Department, The Third People’s Hospital of Yichang City, No. 23, Gangyao Road, Xiling District, Yichang City, Hubei Province, China. https://orcid.org/0009-0005-0283-3094
• Wen Lu Department of Critical Care Medicine, The Third People’s Hospital of Yichang City, No. 23, Gangyao Road, Xiling District, Yichang City, Hubei Province, China. https://orcid.org/0009-0000-1845-3962
• Gege Fang Department of Pulmonary Medicine III, The Third People’s Hospital of Yichang City, No. 23, Gangyao Road, Xiling District, Yichang City, Hubei Province, China. https://orcid.org/0009-0004-5947-6131
• Wei Zhang Department of Critical Care Medicine, The Third People’s Hospital of Yichang City, No. 23, Gangyao Road, Xiling District, Yichang City, Hubei Province, China. https://orcid.org/0009-0003-4892-0973

DOI: https://doi.org/10.54817/IC.v67n1a08

Palabras clave: Acinetobacter baumannii, Neumonía, Resistencia a Múltiples Medicamentos, Factores de riesgo, Tigeciclina

Resumen

El objetivo del trabajo fue explorar los factores de riesgo de resistencia a múltiples medicamentos en pacientes con neumonía por Acine- tobacter baumannii (MDRAB), los factores de riesgo de muerte por todas las causas en 30 días y las estrategias de tratamiento. Este estudio retrospectivo (febrero de 2022-febrero de 2025) analizó datos de 168 pacientes con neu- monía por MDRAB y de 141 con neumonía por Non-MDRAB. Al segundo día, los pacientes con neumonía por MDRAB presentaron mayor gravedad y ma- yor uso de carbapenémicos y tigeciclina que los de Non-MDRAB (p<0,05). Los factores de riesgo significativamente asociados con neumonía por MDRAB in- cluyeron estancia en UCI previa a la infección por AB (p<0,001), puntuación APACHE II≥18 (p=0,002), procedimientos invasivos (p<0,001), shock séptico (p=0,002) y abuso de drogas (p<0,001). La estancia en UCI previa al cultivo, cirugía reciente, puntaje APACHE II ≥ 18, tratamiento con tigeciclina y uso de ≥ 2 antibióticos (todos p<0,05) se asociaron significativamente con la mor- talidad a 30 días. La cohorte de 168 pacientes con MDRAB mostró una tasa de mortalidad a 30 días significativamente menor en el grupo sin tigeciclina (n=85) que en el grupo con tigeciclina (n=83) (p=0,003). En el tratamiento con tigeciclina, la incidencia de eventos adversos gastrointestinales fue mayor y la de reacciones alérgicas, menor (ambas p<0,05). En conclusión, la admisión previa en UCI, los procedimientos invasivos y el abuso de drogas son factores de riesgo para el desarrollo de MDRAB. La enfermedad grave y el tratamiento con tigeciclina se asocian significativamente con una alta mortalidad en pacientes con MDRAB, por lo que debe usarse con precaución.

Citas

Gauba A, Rahman KM. Evaluation of Antibiotic Resistance Mechanisms in Gram-Negative Bacteria. Antibiotics (Basel). 2023;12(11):1590. https://doi.org/10.3390/antibiotics12111590.

Ibrahim S, Al-Saryi N, Al-Kadmy IMS, Aziz SN. Multidrug-resistant Acinetobacter baumannii as an emerging concern in hospitals. Mol Biol Rep. 2021;48(10):6987- 6998. https://doi.org/10.1007/s11033-021-06690-6.

Li Y, Xiao S, Huang G. Acinetobacter baumannii Bacteriophage: Progress in Isolation, Genome Sequencing, Preclinical Research, and Clinical Application. Curr Microbiol. 2023;80(6):199. https://doi.org/10.1007/s00284-023-03295-z.

Tiku V. Acinetobacter baumannii: Virulence Strategies and Host Defense Mechanisms. DNA Cell Biol. 2022;41(1):43-48. https://doi.org/10.1089/dna.2021.0588.

Singh S, Singh S, Trivedi M, Dwivedi M. An insight into MDR Acinetobacter baumannii infection and its pathogenesis: Potential therapeutic targets and challenges. Microb Pathog. 2024;192:106674. https://doi.org/10.1016/j.micpath.2024.106674.

Mea HJ, Yong PVC, Wong EH. An overview of Acinetobacter baumannii pathogenesis: Motility, adherence and biofilm formation. Microbiol Res. 2021;247:126722. https://doi.org/10.1016/j.micres.2021.126722.

Shi J, Cheng J, Liu S, Zhu Y, Zhu M. Acinetobacter baumannii: an evolving and cunning opponent. Front Microbiol. 2024;15:1332108. https://doi.org/10.3389/fmicb.2024.1332108.

Luo Q, Chang M, Lu P, Guo Q, Jiang X, Xiao T, et al. Genomic epidemiology and phylodynamics of Acinetobacter baumannii bloodstream isolates in China. Nat Commun. 2025, 16: 3536. https://doi.org/10.1038/s41467-025-58772-9.

Gautam D, Dolma KG, Khandelwal B, Mitsuwan W, Mahboob T, Pereira ML, et al. Acinetobacter baumannii: An overview of emerging multidrug-resistant pathogen. Med J Malaysia. 2022;77(3):357-370. PMID: 35638493.

Marino A, Augello E, Stracquadanio S, Bellanca CM, Cosentino F, Spampinato S, et al. Unveiling the Secrets of Acinetobacter baumannii: Resistance, Current Treatments, and Future Innovations. Int J Mol Sci. 2024;25(13):6814. https://doi.org/10.3390/ijms25136814.

Jo J, Ko KS. Tigecycline Heteroresistance and Resistance Mechanism in Clinical Isolates of Acinetobacter baumannii. Microbiol Spectr. 2021;9(2):e0101021. https://doi.org/10.1128/Spectrum.01010-21.

Sun C, Yu Y, Hua X. Resistance mechanisms of tigecycline in Acinetobacter baumannii. Front Cell Infect Microbiol. 2023;13:1141490. https://doi.org/10.3389/fcimb.2023.1141490.

Bartal C, Rolston KVI, Nesher L. Carbapenem-resistant Acinetobacter baumannii: Colonization, Infection and Current Treatment Options. Infect Dis Ther. 2022;11(2):683-694. https://doi.org/10.1007/s40121-022-00597-w.

Deng Y, Chen L, Yue M, Huang X, Yang Y, Yu H. Sulbactam combined with tigecycline improves outcomes in patients with severe multidrug-resistant Acinetobacter baumannii pneumonia. BMC Infect Dis. 2022;22(1):795. https://doi.org/10.1186/s12879-022-07778-5.

Al-Tamimi M, Albalawi H, Alkhawaldeh M, Alazzam A, Ramadan H, Altalalwah M, et al. Multidrug-Resistant Acinetobacter baumannii in Jordan. Microorganisms. 2022;10(5):849. https://doi.org/10.3390/microorganisms10050849.

Wen B, Zhang G, Zhan C, Chen C, Yi H. The 2024 revision of the Declaration of Helsinki: a modern ethical framework for medical research. Postgrad Med J. 2025;101(1194):371-382. https://doi.org/10.1093/postmj/qgae181.

Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol. 2021;59(12):e0021321. https://doi.org/10.1128/JCM.00213-21.

Huang H, Chen B, Liu G, Ran J, Lian X, Huang X, et al. A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii. BMC Infect Dis. 2018;18(1):11. https://doi.org/10.1186/s12879-017-2932-5.

Huang SS, Qiu JY, Li SP, Ma YQ, He J, Han LN, et al. Microbial signatures predictive of short-term prognosis in severe pneumonia. Front Cell Infect Microbiol. 2024;14:1397717. https://doi.org/10.3389/fcimb.2024.1397717.

Müller C, Reuter S, Wille J, Xanthopoulou K, Stefanik D, Grundmann H, et al. A global view on carbapenem-resistant Acinetobacter baumannii. mBio. 2023;14(6):e0226023. https://doi.org/10.1128/mbio.02260-23.

Jo J, Kwon KT, Ko KS. Multiple heteroresistance to tigecycline and colistin in Acinetobacter baumannii isolates and its implications for combined antibiotic treatment. J Biomed Sci. 2023;30(1):37. https://doi.org/10.1186/s12929-023-00914-6.

Shein AMS, Hongsing P, Smith OK, Phattharapornjaroen P, Miyanaga K, Cui L, et al. Current and novel therapies for management of Acinetobacter baumannii-associated pneumonia. Crit Rev Microbiol. 2025;51(3):441-462. https://doi.org/10.1080/1040841X.2024.2369948.

Sato Y, Hatayama N, Ubagai T, Tansho-Nagakawa S, Ono Y, Yoshino Y. Tigecycline Suppresses the Virulence Factors of Multi-drug-Resistant Acinetobacter baumannii Allowing Human Neutrophils to Act. Infect Drug Resist. 2022;15:3357-3368. https://doi.org/10.2147/IDR.S368890.

Kyriakidis I, Vasileiou E, Pana ZD, Tragiannidis A. Acinetobacter baumannii Antibiotic Resistance Mechanisms. Pathogens. 2021;10(3):373. https://doi.org/10.3390/pathogens10030373.

Tu Q, Pu M, Li Y, Wang Y, Li M, Song L, et al. Acinetobacter Baumannii Phages: Past, Present and Future. Viruses. 2023; 15(3):673. https://doi.org/10.3390/v15030673.

AlAmri AM, AlQurayan AM, Sebastian T, AlNimr AM. Molecular Surveillance of Multidrug-Resistant Acinetobacter baumannii. Curr Microbiol. 2020;77(3):335-342. https://doi.org/10.1007/s00284-019-01836-z.

Vrancianu CO, Gheorghe I, Czobor IB, Chifiriuc MC. Antibiotic Resistance Profiles, Molecular Mechanisms and Innovative Treatment Strategies of Acinetobacter baumannii. Microorganisms. 2020; 8(6):935. https://doi.org/10.3390/micro-organisms8060935.

Reina R, León-Moya C, Garnacho-Montero J. Treatment of Acinetobacter baumannii severe infections. Med Intensiva (Engl Ed). 2022;46(12):700-710. https://doi.org/10.1016/j.medine.2022.08.007.

Diao H, Lu G, Zhang Y, Wang Z, Liu X, Ma Q, et al. Risk factors for multidrug-resistant and extensively drug-resistant Acinetobacter baumannii infection of patients admitted in intensive care unit: asystematic review and meta-analysis. J Hosp Infect. 2024;149:77-87. https://doi.org/10.1016/j.jhin.2024.04.013.

Gharaibeh MH, Abandeh YM, Elnasser ZA, Lafi SQ, Obeidat HM, Khanfar MA. Multi-drug Resistant Acinetobacter baumannii: Phenotypic and Genotypic Resistance Profiles and the Associated Risk Factors in Teaching Hospital in Jordan. J Infect Public Health. 2024;17(4):543-550. https://doi.org/10.1016/j.jiph.2024.01.018.

Roy S, Chowdhury G, Mukhopadhyay AK, Dutta S, Basu S. Convergence of Biofilm Formation and Antibiotic Resistance in Acinetobacter baumannii Infection. Front Med (Lausanne). 2022;9:793615. https://doi.org/10.3389/fmed.2022.793615.

Lan M, Dongmei K, Guodong S, Haifeng Y, Guofeng C, Mengting C, et al. Risk factors for bacteremic pneumonia and mortality (28-day mortality) in patients with Acinetobacter baumannii bacteremia. BMC Infect Dis. 2024;24(1):448. https://doi.org/10.1186/s12879-024-09335-8.

Sharma R, Lakhanpal D. Acinetobacter baumannii: A comprehensive review of global epidemiology, clinical implications, host interactions, mechanisms of antimicrobial resistance and mitigation strategies. Microb Pathog. 2025;204:107605. https://doi.org/10.1016/j.micpath.2025.107605.

Zhou H, Yao Y, Zhu B, Ren D, Yang Q, Fu Y, et al. Risk factors for acquisition and mortality of multidrug-resistant Acinetobacter baumannii bacteremia: A retrospective study from a Chinese hospital. Medicine (Baltimore). 2019;98(13):e14937. https://doi.org/10.1097/MD.0000000000014937.

Černiauskienė K, Vitkauskienė A. Multidrug-Resistant Acinetobacter baumannii: Risk Factors for Mortality in a Tertiary Care Teaching Hospital. Trop Med Infect Dis. 2025;10(1):15. https://doi.org/10.3390/tropicalmed10010015.

Huang C, Gao Y, Lin H, Fan Q, Chen L, Feng Y. Prognostic Factors That Affect Mortality Patients with Acinetobacter baumannii Bloodstream Infection. Infect Drug Resist. 2024;17:3825-3837. https://doi.org/10.2147/IDR.S475073.

Yu K, Zeng W, Xu Y, Liao W, Xu W, Zhou T, et al. Bloodstream infections caused by ST2 Acinetobacter baumannii: risk factors, antibiotic regimens, and virulence over 6 years period in China. Antimicrob Resist Infect Control. 2021;10(1):16. https://doi.org/10.1186/s13756-020-00876-6.

Zhang S, Di L, Qi Y, Qian X, Wang S. Treatment of infections caused by carbapenem-resistant Acinetobacter baumannii. Front Cell Infect Microbiol. 2024; 14:1395260. https://doi.org/10.3389/fcimb.2024.1395260.

Niu T, Xiao T, Guo L, Yu W, Chen Y, Zheng B, et al. Retrospective comparative analysis of risk factors and outcomes in patients with carbapenem-resistant Acinetobacter baumannii bloodstream infections: cefoperazone-sulbactam associated with resistance and tigecycline increased the mortality. Infect Drug Resist. 2018;11:2021-2030. https://doi.org/10.2147/IDR.S169432.

Gu S, Xiong J, Peng S, Hu L, Zhu H, Xiao Y, et al. Assessment of Effective Antimicrobial Regimens and Mortality-Related Risk Factors for Bloodstream Infections Caused by Carbapenem-Resistant Acinetobacter baumannii. Infect Drug Resist. 2023;16:2589-2600. https://doi.org/10.2147/IDR.S408927.

Mei H, Yang T, Wang J, Wang R, Cai Y. Efficacy and safety of tigecycline in treatment of pneumonia caused by MDR Acinetobacter baumannii: a systematic review and meta-analysis. J Antimicrob Chemother. 2019;74(12):3423-3431. https://doi.org/10.1093/jac/dkz337.

Yaghoubi S, Zekiy AO, Krutova M, Gholami M, Kouhsari E, Sholeh M, et al. Tigecycline antibacterial activity, clinical effectiveness, and mechanisms and epidemiology of resistance: narrative review. Eur J Clin Microbiol Infect Dis. 2022;41(7):1003-1022. https://doi.org/10.1007/s10096-020-04121-1.