Bloodstream infections caused by Acinetobacter species with reduced susceptibility to tigecycline: clinical features and risk factorsopen access
- Authors
- Park, G.E.[Park, G.E.]; Kang, C.-I.[Kang, C.-I.]; Cha, M.K.[ Cha, M.K.]; Cho, S.Y.[ Cho, S.Y.]; Seok, H.[ Seok, H.]; Lee, J.H.[ Lee, J.H.]; Kim, J.Y.[ Kim, J.Y.]; Ha, Y.E.[ Ha, Y.E.]; Chung, D.R.[Chung, D.R.]; Peck, K.R.[Peck, K.R.]; Lee, N.Y.[Lee, N.Y.]; Song, J.-H.[Song, J.-H.]
- Issue Date
- Sep-2017
- Publisher
- ELSEVIER SCI LTD
- Keywords
- Acinetobacter species; Non-susceptible; Tigecycline
- Citation
- INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, v.62, pp.26 - 31
- Indexed
- SCIE
SCOPUS
- Journal Title
- INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
- Volume
- 62
- Start Page
- 26
- End Page
- 31
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/27726
- DOI
- 10.1016/j.ijid.2017.06.023
- ISSN
- 1201-9712
- Abstract
- Introduction: During recent decades, the rates of multidrug resistance, including resistance to carbapenems, have increased dramatically among Acinetobacter species. Tigecycline has activity against multidrug-resistant Acinetobacter spp, including carbapenem-resistant isolates. However, reports of tigecycline-resistant Acinetobacter spp are emerging from different parts of the world. The purpose of this study was to evaluate potential risk factors associated with tigecycline non-susceptible Acinetobacter bacteremia. Methods: The medical records of 152 patients with Acinetobacter bacteremia attending Samsung Medical Center between January 2010 and December 2014 were reviewed. Non-susceptibility to tigecycline was defined as a minimum inhibitory concentration (MIC) of tigecycline >= 4 mu g/ml. Cases were patients with tigecycline non-susceptible Acinetobacter bacteremia and controls were those with tigecycline-susceptible Acinetobacter bacteremia. Results: Of the 152 patients included in the study, 61 (40.1%) had tigecycline non-susceptible Acinetobacter bacteremia (case group). These patients were compared to 91 patients with tigecycline-susceptible Acinetobacter bacteremia (control group). The case group showed high resistance to other antibiotics (> 90%) except colistin (6.6%) and minocycline (9.8%) when compared to the control group, which exhibited relatively low resistance to other antibiotics (< 50%). Multivariate analysis showed that recent exposure to corticosteroids (minimum 20 mg per day for more than 5 days within 2 weeks) (adjusted odds ratio (OR) 2.887, 95% confidence interval (CI) 1.170-7.126) and carbapenems (within 2 weeks) (adjusted OR 4.437, 95% CI 1.970-9.991) were significantly associated with tigecycline nonsusceptible Acinetobacter bacteremia. Although prior exposure to tigecycline was more common in the case group than in the control group (9.8%, 6/61 vs. 2.2%, 2/91; p = 0.046), this variable was found not to be a significant factor associated with tigecycline non-susceptibility after adjustment for other variables (adjusted OR 1.884, 95% CI 0.298-11.920; p = 0.501). Conclusions: These data suggest that tigecycline non-susceptible Acinetobacter spp have emerged and disseminated in the hospital in association with a recent exposure to carbapenems and an immunosuppressed state. This indicates that the rational use of antibiotics through a comprehensive antimicrobial stewardship program, especially in immunosuppressed patients, may be essential in limiting the emergence and spread of multidrug-resistant organisms such as tigecycline-resistant Acinetobacter spp, which are difficult to treat. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
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