{"title":"重症监护病房耐碳青霉烯鲍曼不动杆菌血流感染的结局及不同抗菌方案的预后影响。","authors":"Chieh-Lung Chen, Kuang-Yao Yang, Chung-Kan Peng, Ming-Cheng Chan, Chau-Chyun Sheu, Jia-Yih Feng, Sheng-Huei Wang, Wei-Hsuan Huang, Chia-Min Chen, How-Yang Tseng, Yu-Chao Lin","doi":"10.1186/s13613-025-01580-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant global threat due to limited therapeutic options and high rates of associated mortality. CRAB-related bloodstream infections (BSIs) in intensive care units (ICUs) represent a major clinical challenge. This study aimed to investigate the clinical outcomes of CRAB-BSIs in ICU settings and evaluate the prognostic effect of different antimicrobial regimens.</p><p><strong>Methods: </strong>This multicenter, retrospective observational study was conducted at five medical centers in Taiwan and included 393 critically ill patients with CRAB-BSIs between January 2015 and December 2019. Clinical and microbiological outcomes were analyzed. Multivariable regression analysis was used to identify independent prognostic factors for day-28 mortality.</p><p><strong>Results: </strong>The most common causes of CRAB-BSIs were pneumonia (42.5%) and catheter-related infections (38.7%). The day-28 mortality rate following BSI onset was 56.5%. A higher sequential organ failure assessment (SOFA) score independently predicted increased day-28 mortality. Colistin-based therapy was associated with improved survival outcomes in the original (adjusted hazard ratio [aHR], 0.56; 95% confidence intervals (CI), 0.35-0.88) and time-window bias-adjusted (aHR, 0.59; 95% CI, 0.37-0.94) cohorts. Among patients with pneumonia-related CRAB-BSIs, colistin-based therapy did not significantly improve day-28 survival, whereas sulbactam-based therapy showed survival benefit (aHR, 0.37; 95% CI, 0.15-0.91). Neither carbapenem-based nor tigecycline-based therapies demonstrated a mortality benefit on day 28.</p><p><strong>Conclusion: </strong>CRAB-BSIs are associated with high mortality in critically ill patients. In settings where novel antibiotics are not available, colistin-based therapy was associated with improved clinical outcomes. Among patients with pneumonia-related CRAB-BSIs, sulbactam-based therapy was associated with lower mortality.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"162"},"PeriodicalIF":5.5000,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534662/pdf/","citationCount":"0","resultStr":"{\"title\":\"Outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections in intensive care units and prognostic effect of different antimicrobial regimens.\",\"authors\":\"Chieh-Lung Chen, Kuang-Yao Yang, Chung-Kan Peng, Ming-Cheng Chan, Chau-Chyun Sheu, Jia-Yih Feng, Sheng-Huei Wang, Wei-Hsuan Huang, Chia-Min Chen, How-Yang Tseng, Yu-Chao Lin\",\"doi\":\"10.1186/s13613-025-01580-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant global threat due to limited therapeutic options and high rates of associated mortality. CRAB-related bloodstream infections (BSIs) in intensive care units (ICUs) represent a major clinical challenge. This study aimed to investigate the clinical outcomes of CRAB-BSIs in ICU settings and evaluate the prognostic effect of different antimicrobial regimens.</p><p><strong>Methods: </strong>This multicenter, retrospective observational study was conducted at five medical centers in Taiwan and included 393 critically ill patients with CRAB-BSIs between January 2015 and December 2019. Clinical and microbiological outcomes were analyzed. Multivariable regression analysis was used to identify independent prognostic factors for day-28 mortality.</p><p><strong>Results: </strong>The most common causes of CRAB-BSIs were pneumonia (42.5%) and catheter-related infections (38.7%). The day-28 mortality rate following BSI onset was 56.5%. A higher sequential organ failure assessment (SOFA) score independently predicted increased day-28 mortality. Colistin-based therapy was associated with improved survival outcomes in the original (adjusted hazard ratio [aHR], 0.56; 95% confidence intervals (CI), 0.35-0.88) and time-window bias-adjusted (aHR, 0.59; 95% CI, 0.37-0.94) cohorts. Among patients with pneumonia-related CRAB-BSIs, colistin-based therapy did not significantly improve day-28 survival, whereas sulbactam-based therapy showed survival benefit (aHR, 0.37; 95% CI, 0.15-0.91). Neither carbapenem-based nor tigecycline-based therapies demonstrated a mortality benefit on day 28.</p><p><strong>Conclusion: </strong>CRAB-BSIs are associated with high mortality in critically ill patients. In settings where novel antibiotics are not available, colistin-based therapy was associated with improved clinical outcomes. Among patients with pneumonia-related CRAB-BSIs, sulbactam-based therapy was associated with lower mortality.</p>\",\"PeriodicalId\":7966,\"journal\":{\"name\":\"Annals of Intensive Care\",\"volume\":\"15 1\",\"pages\":\"162\"},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2025-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534662/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13613-025-01580-7\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13613-025-01580-7","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections in intensive care units and prognostic effect of different antimicrobial regimens.
Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant global threat due to limited therapeutic options and high rates of associated mortality. CRAB-related bloodstream infections (BSIs) in intensive care units (ICUs) represent a major clinical challenge. This study aimed to investigate the clinical outcomes of CRAB-BSIs in ICU settings and evaluate the prognostic effect of different antimicrobial regimens.
Methods: This multicenter, retrospective observational study was conducted at five medical centers in Taiwan and included 393 critically ill patients with CRAB-BSIs between January 2015 and December 2019. Clinical and microbiological outcomes were analyzed. Multivariable regression analysis was used to identify independent prognostic factors for day-28 mortality.
Results: The most common causes of CRAB-BSIs were pneumonia (42.5%) and catheter-related infections (38.7%). The day-28 mortality rate following BSI onset was 56.5%. A higher sequential organ failure assessment (SOFA) score independently predicted increased day-28 mortality. Colistin-based therapy was associated with improved survival outcomes in the original (adjusted hazard ratio [aHR], 0.56; 95% confidence intervals (CI), 0.35-0.88) and time-window bias-adjusted (aHR, 0.59; 95% CI, 0.37-0.94) cohorts. Among patients with pneumonia-related CRAB-BSIs, colistin-based therapy did not significantly improve day-28 survival, whereas sulbactam-based therapy showed survival benefit (aHR, 0.37; 95% CI, 0.15-0.91). Neither carbapenem-based nor tigecycline-based therapies demonstrated a mortality benefit on day 28.
Conclusion: CRAB-BSIs are associated with high mortality in critically ill patients. In settings where novel antibiotics are not available, colistin-based therapy was associated with improved clinical outcomes. Among patients with pneumonia-related CRAB-BSIs, sulbactam-based therapy was associated with lower mortality.
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
