The mortality rate ofAcinetobacter baumannii is as high as 47%,This is inseparable From its strong resistance to carbapenems,polymyxins,aminoglycosides,quinolone antibiotics.This article will analyze the resistance of...The mortality rate ofAcinetobacter baumannii is as high as 47%,This is inseparable From its strong resistance to carbapenems,polymyxins,aminoglycosides,quinolone antibiotics.This article will analyze the resistance of Acinetobacter baumannii to carbapenem antibiotics(meropenem and imipenem)and explore why Acinetobacter baumannii is so resistant.The data I used comes from the NCBI database,which includes six resistant groups(R)to meropenem and imipenem,and five sensitive groups(S).The level of the resistant group is complete genome,three sensitive groups are contig,and two are complete genome.Subsequently,I used Prokka in Galaxy to convert the Fasta.file into various forms such as Faa,gbk,ffn.After performing Fisher's test on all GFF files,I obtained the result chart,which includes the search for relevant domains and protein descriptions on Interpro using the chart.ProteinPlus also performed drug pocket prediction and constructed protein models using Swissmodel,as well as different multi sequence comparisons.Finally,I analyzed the functions of the proteins corresponding to the genes specific to the resistance group and the reasons for the development of drug resistance,making future research on the drug resistance of Acinetobacter baumannii easier.And further research can be conducted on the drug pocket in the protein ofAcinetobacter baumannii that has developed resistance,and drugs can be administered.展开更多
Objective:To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii(A.baumannii)isolates in this study.Methods:A.baumannii isolates were collected from...Objective:To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii(A.baumannii)isolates in this study.Methods:A.baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study,and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2®systems.All isolates were analyzed for biofilm production,then presence of biofilm-associated genes,and class Ⅰ and Ⅱ integron genes.Results:60 non-replicate A.baumannii isolates were included in this study.The resistance rates reached 100%for aztreonam,cefepime,ceftazidime,ciprofloxacin,piperacillin-tazobactam,piperacillin,ticarcillin,and trimethoprim-sulfamethoxazole.A.baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments.Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3%and 16.7%,respectively.Of the isolates,91.6%formed biofilms,categorized as 10%strong,31.6%moderate,and 50%weak.No correlation was found between antibiotic resistance and biofilm formation.The genes csuE,abaI,and ompA were prevalent,but their distribution was similar across biofilm categories.A relationship between Int1 and biofilm production was noted.Conclusions:The high rates of antibiotic resistance and biofilm formation,alongside the presence of integrons including class Ⅰ and Ⅱ,underscore the necessity for ongoing monitoring of A.baumannii.Notably,classⅠintegron presence was significantly linked to biofilm formation.Further research is needed to explore the connection between antibiotic resistance and biofilm production in A.baumannii.展开更多
Acinetobacter(A.)baumannii is a Gram-negative,non-fermenting opportunistic pathogen increasingly implicated in nosocomial infections,particularly in intensive care units(ICUs).Its ability to acquire multidrug resistan...Acinetobacter(A.)baumannii is a Gram-negative,non-fermenting opportunistic pathogen increasingly implicated in nosocomial infections,particularly in intensive care units(ICUs).Its ability to acquire multidrug resistance(MDR),including to carbapenems,poses a major public health threat.Infections caused by A.baumannii-ranging from pneumonia to bloodstream and wound infections-are difficult to treat and associated with high mortality,especially in critically ill patients[1].展开更多
Fournier’s gangrene is a rare urological condition with a poor prognosis and an extremely high mortality rate.Infections caused by pathogenic microorganisms play a critical role in the pathogenesis of Fournier’s gan...Fournier’s gangrene is a rare urological condition with a poor prognosis and an extremely high mortality rate.Infections caused by pathogenic microorganisms play a critical role in the pathogenesis of Fournier’s gangrene.Rapid assessment and thorough debridement are crucial for survival and prognosis of patients with this disease.The present case involved a 62-year-old male patient with poorly controlled diabetes,who presented with unexplained scrotal swelling for 2 days at a local hospital where scrotal surgical debridement was performed.However,the procedure was unsuccessful.This case was characterized by rapid disease progression,widespread wound involvement,and dual infection with multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa.Our team performed early,extensive surgical debridement and,based on the results of antimicrobial susceptibility testing,initiated combination antibiotic therapy.The patient’s condition improved significantly after these interventions.However,the treatment was ultimately discontinued by the patient’s family for personal reasons,and follow-up care was declined.展开更多
Acinetobacter baumannii(A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent year...Acinetobacter baumannii(A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrugresistant A. baumannii(MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections.展开更多
Objective: To check biofilm formation by Acinetobacter baumannii(A. baumannii)clinical isolates and show their susceptibility to different antibiotics and investigate a possible link between establishment of biofilm a...Objective: To check biofilm formation by Acinetobacter baumannii(A. baumannii)clinical isolates and show their susceptibility to different antibiotics and investigate a possible link between establishment of biofilm and multidrug resistance.Methods: This study was performed on clinical samples collected from patients with nosocomial infections in three hospitals of Tehran. Samples were initially screened by culture and biochemical tests for the presence of different species of Acinetobacter. Identifications were further confirmed by PCR assays. Their susceptibilities to 11 antibiotics of different classes were determined by disc diffusion method according to Clinical and Laboratory Standards Institute guidelines. The ability to produce biofilm was investigated using methods: culture on Congo red agar, microtiter plate, and test tube method.Results: From the overall clinical samples, 156 specimens were confirmed to contain A. baumannii. The bacteria were highly resistant to most antibiotics except polymyxin B.Of these isolates, 10.26% were able to produce biofilms as shown on Congo red agar.However, the percentage of bacteria with positive biofilm in test tube, standard microtiter plate, and modified microtiter plate assays were 48.72%, 66.66%, and 73.72%, respectively. At least 92% of the biofilm forming isolates were multidrug resistant.Conclusions: Since most of the multidrug resistant strains produce biofilm, it seems necessary to provide continuous monitoring and determination of antibiotic susceptibility of clinical A. baumannii. This would help to select the most appropriate antibiotic for treatment.展开更多
Acinetobacter baumannii causes serious infections especially in immunocompromised and/or hospitalized patients.Several A.baumannii strains are multidrug resistant and infect wounds,bones,and the respiratory tract.Curr...Acinetobacter baumannii causes serious infections especially in immunocompromised and/or hospitalized patients.Several A.baumannii strains are multidrug resistant and infect wounds,bones,and the respiratory tract.Current studies are focused on finding new effective agents against A.baumannii.Phage therapy is a promising means to fight this bacterium and many studies on procuring and applying new phages against A.baumannii are currently being conducted.As shown in animal models,phages against multidrug-resistant A.baumannii may control bacterial infections caused by this pathogen and may be a real hope to solve this dangerous health problem.展开更多
Background:Intracranial infection after craniotomy is one of the most serious postoperative complications,especially multidrug-resistant(MDR)or extensively drug-resistant(XDR)bacterial meningitis,and strongly affects ...Background:Intracranial infection after craniotomy is one of the most serious postoperative complications,especially multidrug-resistant(MDR)or extensively drug-resistant(XDR)bacterial meningitis,and strongly affects the prognosis of patients.Current treatment experience regarding these infections is scarce.Case presentation:We report a case of severe intracranial infection of XDR Acinetobacter baumannii(A.baumannii)that was treated by intravenous(IV)injection,sequential intraventricular(IVT)injection of tigecycline and polymyxin B,and other anti-infective drugs.Good results were obtained,and the patient was eventually discharged from the hospital.This case is characterized by intracranial infection.Conclusions:The polymyxin B IV+IVT pathway is an ideal treatment strategy for XDR A.baumannii.The tigecycline IVT pathway is also a safe treatment option.展开更多
BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics ...BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics available.Carbapenem resistance is common and colistin resistance is rare in our country.Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country.AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and-resistant Acinetobacter sp.Strains.METHODS During the study period,108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively.Continuous variables were compared with the Mann-Whitney U test,and categorical variables were compared using Pearson’s chi-square test or Fisher’s Exact chi-square test for two groups.A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains.RESULTS High Acute Physiology and Chronic Health Evaluation II scores(OR=1.9,95%CI:1.4-2.7;P<0.001)and prior receipt of teicoplanin(OR=8.1,95%CI:1.0-63.3;P=0.045)were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp.Different combinations of antibiotics including colistin,meropenem,ampicillin/sulbactam,amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains.Although the median duration of microbiological cure(P<0.001)was longer in the colistin-resistant group,clinical(P=0.703),laboratory(P=0.277),radiological(P=0.551),microbiological response(P=1.000)and infection related mortality rates(P=0.603)did not differ between the two groups.Among the patients with infections due to colistin-resistant strains,seven were treated with antibiotic combinations that included sulbactam.Clinical(6/7)and microbiological(5/7)response rates were quite high in these patients.CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp.infections.Although combinations with sulbactam seems to be more effective in our study patients,data supporting the usefulness of combinations with sulbactam is very limited.展开更多
Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers.Methods:Antibiotic susceptibility testing was performed by agar diffusio...Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers.Methods:Antibiotic susceptibility testing was performed by agar diffusion and agar dilution methods,resistance genes were identified by PCR and sequencing,and molecular typing of isolates was carried out by enterobacterial repetitive intergenic consensus-PCR(ERIC-PCR).Results:Among 125 tested isolates,117(93.6% ) were multidrug-resistant.of which 94(75.2% ) were imipenem resistant.The bla_(ADC)and bla_(OXA-51-like) genes were detected in all isolates,in association with ISAba I sequence in 84% and 8% (imipenem resistant) of isolates,respectively.The bla_(OXA-23-like) and bla_(OXA-24-like)carbapenemase genes were delected in 67.02% and 20.21% of imipenem-resistant isolates,respectively.The bla_(OXA-23-like) gene is linked to ISAba1 or ISAba4 elements.The metallo-β-lactamase NDM-1 gene was found in 10(10.6% ) imipenem-resisianl strains from three hospitals,it is linked to ISAba125 clement in nine strains.Extended spectrum β-lactamases production was not detected.Imipenem and cefotaxime resistance phenolypes could not be transferred to Escherichia coli by conjugation.Outer membrane protein CarO gene was not delected in four imipenem-resisianl isolates.The aac(6')-1b.sul1,sul2,tetA and tetB genes were present in 5.31% .36.17% .77.65% .1.06% and 65.92% of strains,respectively.Class 1 integrons were detected in 23.4% strains.KRIC-PCR typing showed a genetic diversity among bla_(OXA-23-like) and bla_(OXA-24-like) positive strains,while clonality was observed among bla_(NDM-1)positives.Conclusions:This study highlighted the high prevalence of imipenem resistance in Acinetobacter baumannii in Algiers hospitals mediated mainly by bla_(OXA-23-like),bla_(OXA-24-like),and bla_(NDM-1) genes.展开更多
Objective:To investigate antibiotic resistance and carriage class 1 and 2 integrons in clinical isolates of Acinetobacter baumannii(A.baumannii)from Tehran,Iran.Methods:Antimicrobial susceptibility testing was perform...Objective:To investigate antibiotic resistance and carriage class 1 and 2 integrons in clinical isolates of Acinetobacter baumannii(A.baumannii)from Tehran,Iran.Methods:Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute.The presence of integrons was investigated by PCR using specific primers.Results:Among isolated A.baumannii strains,82%were multidrug resistant,27 samples(54%)were resistant to three or more than three antibiotics and 16 samples(32%)showed resistance to two antibiotics.Integrons were detected from 44 of 50 isolates(88%),with classes 1 and 2 being observed in 42%(21/50)and 82%(41/50)of isolates,respectively.Integron-positive A.baumannii isolates showed higher antibiotic resistance than integron-negative isolates and all showed a multidrug-resistant phenotype.Conclusions:Our findings show that classes 1 and 2 integrons,and especially classes 2 integrons are widely disseminated among A.baumannii strains isolated from Tehran and these structures are playing a major role in the acquisition of multidrug resistance in these strains.So monitoring of drug resistance with investigating carriage class 1 and 2 integrons is very important to plan specific infection control measures due to multidrug resistance A.baumannii in Iran hospitals.展开更多
We report an atypical case of anti-N-methyl-D-aspartate receptor encephalitis(ANMDARE). A 27-year-old man diagnosed with ANMDARE received immunotherapy and had a good recovery. However, within one month, he developed ...We report an atypical case of anti-N-methyl-D-aspartate receptor encephalitis(ANMDARE). A 27-year-old man diagnosed with ANMDARE received immunotherapy and had a good recovery. However, within one month, he developed severe status epilepticus and decreased level of conscience with new hyperpyrexia and dyspnea, and was admitted to the emergency intensive care unit. Acinetobacter baumanii were found in the sputum culture; and anti-NMDAR antibodies were positive(titer: 1/80) in the cerebrospinal fluid. Repeated immunotherapy was administered with antibacterial agents, and the patient recovered except for mild psychiatric sequelae. This is the first report of ANMDARE that aggravates after acinetobacter baumannii pneumonia. Awareness and knowledge of this disorder should be extended, especially in the emergency medicine community.展开更多
Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus(MRSA)are two prevalent pathogens and have developed high resistant to most antibiotics.Therefore,it is a pressing need to develop a new method to...Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus(MRSA)are two prevalent pathogens and have developed high resistant to most antibiotics.Therefore,it is a pressing need to develop a new method to inhibit the spread of drug-resistant bacteria.Copper containing high-entropy alloy(HEA,Al0.4CoCr-CuFeNi)is a new kind of alloy material,which shows extensive antibacterial activity and mechanical properties in our previous research.This study further develops another HEA(CoCrCuFeNi)and evaluates its resistance against gram-negative A.baumannii and Gram-positive MRSA.The antibacterial tests show that the antibacterial rate of the HEA toward both bacteria reached nearly 99%,far better than the traditional copper-bearing 304 stainless steel(304 Cu-SS).The biofilm observation shows that the HEA could not only kill the planktonic bacteria,but also effectively inhibit the formation of biofilm.These data demonstrate that CoCrCuFeNi HEA possesses effective antibacterial and antibiofilm activities,making it a potential candidate for using in hospital,food industry,and domestic kitchens.展开更多
Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of...Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of 281 A.baumannii clinical isolates were collected from nine diferenl state hospitals in Turkey and were confirmed as A.baumannU by conventional biochemical,API testing and bla_(-OXA-51)specific PCR.The isolates were examined by PCR for existence of class I and2 integron gene cassettes.Results:They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin(90.03%),ciprofloxacin(87.54%),cefepime and trimethoprim/sulfamethoxazole(81.13%).The lowest resistance rates was for cefotaxime(3.55%).class 1 integrons were detected in 6.4%(18/281)of A.baumannii strains and no class 2 integron was detected.The gene casselles of class 1 inlegrons AacCI-AAC(3)l-aadAI,AacCI-aadA1,AAC(3)-I,AAC(3)-I-AAC(3)-I-aadA1,TEM-1.AAC(3)-I-aadA1-AAC(3)-I-AAC(3)-I,AAC(3)-I-AAC(3)-I-AAC(3)-I-aadA1,AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I,AAC(3)-I-aadA1-AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains.The aac genes family were most frequently found integrated into the class 1 inlegrons and it was followed by aadA genes and TEM-1 genes.Conclusions:This is an extensive study on the distribulion of class 1 integron among A.baumannii in Turkey.In addition to these,two new alleles were observed.Their percentage rates of similarity to other cassettes are 95%aadA1(TK A18)and 89%,aadA 1(ANKA3).展开更多
Acinetobacter baumannii is a major cause of nosocomial infections worldwide. By summarizing the epidemiology, molecular and drug resistance mechanisms, diagnosis and treatment strategies of Acinetobacter baumannii, th...Acinetobacter baumannii is a major cause of nosocomial infections worldwide. By summarizing the epidemiology, molecular and drug resistance mechanisms, diagnosis and treatment strategies of Acinetobacter baumannii, the clinical outcome is finally improved.展开更多
BACKGROUND:The Acinetobacter baumannii group,including Acinetobacter baumannii,Acinetobacter genomospecies 3 and 13 TU,is phenotypically indistinguishable and uniformly identified as Acinetobacter baumannii by laborat...BACKGROUND:The Acinetobacter baumannii group,including Acinetobacter baumannii,Acinetobacter genomospecies 3 and 13 TU,is phenotypically indistinguishable and uniformly identified as Acinetobacter baumannii by laboratories of clinical microbiology.This review aimed to demonstrate the differences among them.METHODS:Literatures associated with the Acinetobacter baumannii group were identified and selected from PubMed databases and relevant journals.RESULTS:Acinetobacter genospecies 3 and 13 TU possess a certain proportion in clinical isolates.There were considerable differences in epidemiologic features,clinical manifestations,antimicrobial resistances and therapeutic options among the Acinetobacter baumannii group.Compared with Acinetobacter genomospecies 3 and 13 TU,Acinetobacter baumannii with a higher resistance to antimicrobial agents are easier to be treated inappropriately,and present a worse outcome in patients.CONCLUSION:The Acinetobacter baumannii group comprises three distinct clinical entities,and their clinical value are not equal.展开更多
BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patie...BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.展开更多
BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist f...BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.展开更多
IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic s...IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock. As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.展开更多
AIM: To describe the intensive care unit(ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii(AB) infection.METHODS: This was an observational study that included 23 consecutive cancer patients...AIM: To describe the intensive care unit(ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii(AB) infection.METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico(INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23(4.6%) of whom developed AB infections. Sixteen(60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock(56.2%) and postoperative care(21.7%). The respiratory tract was the most frequent site of AB infection(91.3%). The most common organ dysfunction observed in our group of patients were the respiratory(100%), cardiovascular(100%), hepatic(73.9%) and renal dysfunction(65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7%(2/17) compared with 66.6%(4/6) for the group of patients with 4 or more organ system dysfunctions(P = 0.021). Multivariate analysis identified blood lactate levels(BLL) as the only variable independently associated with inICU death(OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.展开更多
文摘The mortality rate ofAcinetobacter baumannii is as high as 47%,This is inseparable From its strong resistance to carbapenems,polymyxins,aminoglycosides,quinolone antibiotics.This article will analyze the resistance of Acinetobacter baumannii to carbapenem antibiotics(meropenem and imipenem)and explore why Acinetobacter baumannii is so resistant.The data I used comes from the NCBI database,which includes six resistant groups(R)to meropenem and imipenem,and five sensitive groups(S).The level of the resistant group is complete genome,three sensitive groups are contig,and two are complete genome.Subsequently,I used Prokka in Galaxy to convert the Fasta.file into various forms such as Faa,gbk,ffn.After performing Fisher's test on all GFF files,I obtained the result chart,which includes the search for relevant domains and protein descriptions on Interpro using the chart.ProteinPlus also performed drug pocket prediction and constructed protein models using Swissmodel,as well as different multi sequence comparisons.Finally,I analyzed the functions of the proteins corresponding to the genes specific to the resistance group and the reasons for the development of drug resistance,making future research on the drug resistance of Acinetobacter baumannii easier.And further research can be conducted on the drug pocket in the protein ofAcinetobacter baumannii that has developed resistance,and drugs can be administered.
基金This study was financially supported by the Vice Chancellor for Research Affairs,Ilam University of Medical Sciences,Ilam,Iran(Project No.1326).
文摘Objective:To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii(A.baumannii)isolates in this study.Methods:A.baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study,and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2®systems.All isolates were analyzed for biofilm production,then presence of biofilm-associated genes,and class Ⅰ and Ⅱ integron genes.Results:60 non-replicate A.baumannii isolates were included in this study.The resistance rates reached 100%for aztreonam,cefepime,ceftazidime,ciprofloxacin,piperacillin-tazobactam,piperacillin,ticarcillin,and trimethoprim-sulfamethoxazole.A.baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments.Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3%and 16.7%,respectively.Of the isolates,91.6%formed biofilms,categorized as 10%strong,31.6%moderate,and 50%weak.No correlation was found between antibiotic resistance and biofilm formation.The genes csuE,abaI,and ompA were prevalent,but their distribution was similar across biofilm categories.A relationship between Int1 and biofilm production was noted.Conclusions:The high rates of antibiotic resistance and biofilm formation,alongside the presence of integrons including class Ⅰ and Ⅱ,underscore the necessity for ongoing monitoring of A.baumannii.Notably,classⅠintegron presence was significantly linked to biofilm formation.Further research is needed to explore the connection between antibiotic resistance and biofilm production in A.baumannii.
基金supported by ICMR-RMRC intramural fund(RMRC/IM/2022/26).
文摘Acinetobacter(A.)baumannii is a Gram-negative,non-fermenting opportunistic pathogen increasingly implicated in nosocomial infections,particularly in intensive care units(ICUs).Its ability to acquire multidrug resistance(MDR),including to carbapenems,poses a major public health threat.Infections caused by A.baumannii-ranging from pneumonia to bloodstream and wound infections-are difficult to treat and associated with high mortality,especially in critically ill patients[1].
基金supported by the Collaborative Innovation Center of China’s Ministry of Education(grant no.2020-39)Constructive Project of Innovative Talent Platform for Precise Repair of Wounds(grant no.2021-3)+1 种基金Scientific Research and Talent Training Fund of Kweichow Moutai Hospital(grant no.2022-13)Shanghai Wang Zhengguo Trauma Medicine Development Foundation(grant no.SZYZ-TR-05).
文摘Fournier’s gangrene is a rare urological condition with a poor prognosis and an extremely high mortality rate.Infections caused by pathogenic microorganisms play a critical role in the pathogenesis of Fournier’s gangrene.Rapid assessment and thorough debridement are crucial for survival and prognosis of patients with this disease.The present case involved a 62-year-old male patient with poorly controlled diabetes,who presented with unexplained scrotal swelling for 2 days at a local hospital where scrotal surgical debridement was performed.However,the procedure was unsuccessful.This case was characterized by rapid disease progression,widespread wound involvement,and dual infection with multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa.Our team performed early,extensive surgical debridement and,based on the results of antimicrobial susceptibility testing,initiated combination antibiotic therapy.The patient’s condition improved significantly after these interventions.However,the treatment was ultimately discontinued by the patient’s family for personal reasons,and follow-up care was declined.
文摘Acinetobacter baumannii(A. baumannii) is undoubtedly one of the most successful pathogens in the modern healthcare system. With invasive procedures, antibiotic use and immunocompromised hosts increasing in recent years, A. baumannii has become endemic in hospitals due to its versatile genetic machinery, which allows it to quickly evolve resistance factors, and to its remarkable ability to tolerate harsh environments. Infections and outbreaks caused by multidrugresistant A. baumannii(MDRAB) are prevalent and have been reported worldwide over the past twenty or more years. To address this problem effectively, knowledge of species identification, typing methods, clinical manifestations, risk factors, and virulence factors is essential. The global epidemiology of MDRAB is monitored by persistent surveillance programs. Because few effective antibiotics are available, clinicians often face serious challenges when treating patients with MDRAB. Therefore, a deep understanding of the resistance mechanisms used by MDRAB can shed light on two possible strategies to combat the dissemination of antimicrobial resistance: stringent infection control and antibiotic treatments, of which colistin-based combination therapy is the mainstream strategy. However, due to the current unsatisfying therapeutic outcomes, there is a great need to develop and evaluate the efficacy of new antibiotics and to understand the role of other potential alternatives, such as antimicrobial peptides, in the treatment of MDRAB infections.
基金Supported by an educational grant for doctoral thesis from Islamic Azad University of Karaj(grant number:11530554922001)
文摘Objective: To check biofilm formation by Acinetobacter baumannii(A. baumannii)clinical isolates and show their susceptibility to different antibiotics and investigate a possible link between establishment of biofilm and multidrug resistance.Methods: This study was performed on clinical samples collected from patients with nosocomial infections in three hospitals of Tehran. Samples were initially screened by culture and biochemical tests for the presence of different species of Acinetobacter. Identifications were further confirmed by PCR assays. Their susceptibilities to 11 antibiotics of different classes were determined by disc diffusion method according to Clinical and Laboratory Standards Institute guidelines. The ability to produce biofilm was investigated using methods: culture on Congo red agar, microtiter plate, and test tube method.Results: From the overall clinical samples, 156 specimens were confirmed to contain A. baumannii. The bacteria were highly resistant to most antibiotics except polymyxin B.Of these isolates, 10.26% were able to produce biofilms as shown on Congo red agar.However, the percentage of bacteria with positive biofilm in test tube, standard microtiter plate, and modified microtiter plate assays were 48.72%, 66.66%, and 73.72%, respectively. At least 92% of the biofilm forming isolates were multidrug resistant.Conclusions: Since most of the multidrug resistant strains produce biofilm, it seems necessary to provide continuous monitoring and determination of antibiotic susceptibility of clinical A. baumannii. This would help to select the most appropriate antibiotic for treatment.
基金supported by the statutory funds from the Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences
文摘Acinetobacter baumannii causes serious infections especially in immunocompromised and/or hospitalized patients.Several A.baumannii strains are multidrug resistant and infect wounds,bones,and the respiratory tract.Current studies are focused on finding new effective agents against A.baumannii.Phage therapy is a promising means to fight this bacterium and many studies on procuring and applying new phages against A.baumannii are currently being conducted.As shown in animal models,phages against multidrug-resistant A.baumannii may control bacterial infections caused by this pathogen and may be a real hope to solve this dangerous health problem.
基金supported by grants from the National Natural Science Foundation of China(81571940,81741125)the Guangzhou Science and Technology Planning Project of China(201504281714528)PLA Logistics Research Project of China(CWH17L020,17CXZ008,18CXZ030)
文摘Background:Intracranial infection after craniotomy is one of the most serious postoperative complications,especially multidrug-resistant(MDR)or extensively drug-resistant(XDR)bacterial meningitis,and strongly affects the prognosis of patients.Current treatment experience regarding these infections is scarce.Case presentation:We report a case of severe intracranial infection of XDR Acinetobacter baumannii(A.baumannii)that was treated by intravenous(IV)injection,sequential intraventricular(IVT)injection of tigecycline and polymyxin B,and other anti-infective drugs.Good results were obtained,and the patient was eventually discharged from the hospital.This case is characterized by intracranial infection.Conclusions:The polymyxin B IV+IVT pathway is an ideal treatment strategy for XDR A.baumannii.The tigecycline IVT pathway is also a safe treatment option.
文摘BACKGROUND Nosocomial infections with carbapenem-resistant Acinetobacter baumanniicalcoaceticus complex(ABC)strains are great problem for intensive care units.ABC strains can develop resistance to all the antibiotics available.Carbapenem resistance is common and colistin resistance is rare in our country.Knowing the risk factors for colistin resistance is important since colistin seems to be the only remaining therapeutic option for the patients with pneumonia due to extensively drug resistant ABC for our country.AIM To investigate the comparison of clinical responses and outcomes between pneumonia patients with colistin-susceptible and-resistant Acinetobacter sp.Strains.METHODS During the study period,108 patients with pneumonia due to colistin-susceptible strains and 16 patients with colistin-resistant strains were included retrospectively.Continuous variables were compared with the Mann-Whitney U test,and categorical variables were compared using Pearson’s chi-square test or Fisher’s Exact chi-square test for two groups.A binary logistic regression model was developed to identify the potential independent factors associated with colistin resistance in patients with colistin-resistant strains.RESULTS High Acute Physiology and Chronic Health Evaluation II scores(OR=1.9,95%CI:1.4-2.7;P<0.001)and prior receipt of teicoplanin(OR=8.1,95%CI:1.0-63.3;P=0.045)were found to be independent risk factors for infection with colistin-resistant Acinetobacter sp.Different combinations of antibiotics including colistin,meropenem,ampicillin/sulbactam,amikacin and trimethoprim/sulfamethoxazole were used for the treatment of patients with colistin-resistant strains.Although the median duration of microbiological cure(P<0.001)was longer in the colistin-resistant group,clinical(P=0.703),laboratory(P=0.277),radiological(P=0.551),microbiological response(P=1.000)and infection related mortality rates(P=0.603)did not differ between the two groups.Among the patients with infections due to colistin-resistant strains,seven were treated with antibiotic combinations that included sulbactam.Clinical(6/7)and microbiological(5/7)response rates were quite high in these patients.CONCLUSION The optimal therapy regimen is unclear for colistin-resistant Acinetobacter sp.infections.Although combinations with sulbactam seems to be more effective in our study patients,data supporting the usefulness of combinations with sulbactam is very limited.
基金supported by grants from National Fund for the Research and National Agency for the Development of Research in Health(Algeria)
文摘Objective:To assess and characterize antibiotic resistance in Acinetobacter baumannii strains recovered from 5 health-care facilities in Algiers.Methods:Antibiotic susceptibility testing was performed by agar diffusion and agar dilution methods,resistance genes were identified by PCR and sequencing,and molecular typing of isolates was carried out by enterobacterial repetitive intergenic consensus-PCR(ERIC-PCR).Results:Among 125 tested isolates,117(93.6% ) were multidrug-resistant.of which 94(75.2% ) were imipenem resistant.The bla_(ADC)and bla_(OXA-51-like) genes were detected in all isolates,in association with ISAba I sequence in 84% and 8% (imipenem resistant) of isolates,respectively.The bla_(OXA-23-like) and bla_(OXA-24-like)carbapenemase genes were delected in 67.02% and 20.21% of imipenem-resistant isolates,respectively.The bla_(OXA-23-like) gene is linked to ISAba1 or ISAba4 elements.The metallo-β-lactamase NDM-1 gene was found in 10(10.6% ) imipenem-resisianl strains from three hospitals,it is linked to ISAba125 clement in nine strains.Extended spectrum β-lactamases production was not detected.Imipenem and cefotaxime resistance phenolypes could not be transferred to Escherichia coli by conjugation.Outer membrane protein CarO gene was not delected in four imipenem-resisianl isolates.The aac(6')-1b.sul1,sul2,tetA and tetB genes were present in 5.31% .36.17% .77.65% .1.06% and 65.92% of strains,respectively.Class 1 integrons were detected in 23.4% strains.KRIC-PCR typing showed a genetic diversity among bla_(OXA-23-like) and bla_(OXA-24-like) positive strains,while clonality was observed among bla_(NDM-1)positives.Conclusions:This study highlighted the high prevalence of imipenem resistance in Acinetobacter baumannii in Algiers hospitals mediated mainly by bla_(OXA-23-like),bla_(OXA-24-like),and bla_(NDM-1) genes.
基金supported by Cell and Molecular Biology Research Center and Microbiology group of Tehran Medicine University,with grant number TUMS/CMBRC-89-007
文摘Objective:To investigate antibiotic resistance and carriage class 1 and 2 integrons in clinical isolates of Acinetobacter baumannii(A.baumannii)from Tehran,Iran.Methods:Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute.The presence of integrons was investigated by PCR using specific primers.Results:Among isolated A.baumannii strains,82%were multidrug resistant,27 samples(54%)were resistant to three or more than three antibiotics and 16 samples(32%)showed resistance to two antibiotics.Integrons were detected from 44 of 50 isolates(88%),with classes 1 and 2 being observed in 42%(21/50)and 82%(41/50)of isolates,respectively.Integron-positive A.baumannii isolates showed higher antibiotic resistance than integron-negative isolates and all showed a multidrug-resistant phenotype.Conclusions:Our findings show that classes 1 and 2 integrons,and especially classes 2 integrons are widely disseminated among A.baumannii strains isolated from Tehran and these structures are playing a major role in the acquisition of multidrug resistance in these strains.So monitoring of drug resistance with investigating carriage class 1 and 2 integrons is very important to plan specific infection control measures due to multidrug resistance A.baumannii in Iran hospitals.
文摘We report an atypical case of anti-N-methyl-D-aspartate receptor encephalitis(ANMDARE). A 27-year-old man diagnosed with ANMDARE received immunotherapy and had a good recovery. However, within one month, he developed severe status epilepticus and decreased level of conscience with new hyperpyrexia and dyspnea, and was admitted to the emergency intensive care unit. Acinetobacter baumanii were found in the sputum culture; and anti-NMDAR antibodies were positive(titer: 1/80) in the cerebrospinal fluid. Repeated immunotherapy was administered with antibacterial agents, and the patient recovered except for mild psychiatric sequelae. This is the first report of ANMDARE that aggravates after acinetobacter baumannii pneumonia. Awareness and knowledge of this disorder should be extended, especially in the emergency medicine community.
基金This study was financially supported by the Fundamental Research Funds for the Central Universities(Nos.N2002020 and N2002019)the National Natural Science Foundation of China(Nos.51871050,5184022 and 51901039)+1 种基金the National Key Research and Development Program of China(Nos.2019YFA0209901 and 2018YFA0702901)the fund of the State Key Laboratory of Solidification Processing in NWPU(No.SKLSP201902).
文摘Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus(MRSA)are two prevalent pathogens and have developed high resistant to most antibiotics.Therefore,it is a pressing need to develop a new method to inhibit the spread of drug-resistant bacteria.Copper containing high-entropy alloy(HEA,Al0.4CoCr-CuFeNi)is a new kind of alloy material,which shows extensive antibacterial activity and mechanical properties in our previous research.This study further develops another HEA(CoCrCuFeNi)and evaluates its resistance against gram-negative A.baumannii and Gram-positive MRSA.The antibacterial tests show that the antibacterial rate of the HEA toward both bacteria reached nearly 99%,far better than the traditional copper-bearing 304 stainless steel(304 Cu-SS).The biofilm observation shows that the HEA could not only kill the planktonic bacteria,but also effectively inhibit the formation of biofilm.These data demonstrate that CoCrCuFeNi HEA possesses effective antibacterial and antibiofilm activities,making it a potential candidate for using in hospital,food industry,and domestic kitchens.
基金Supported by Recep Tayyip Erdogan University(Grant No.BAP2012.102.03.4.and BAP-2013.102.03.4)
文摘Objective:To investigate the antibiotic resistance genes inserted into class I and class 2integrons in Acinetobacler baumannii[A.baumannii)isolates obtained from nine different cities in Turkey.Methods:A collection of 281 A.baumannii clinical isolates were collected from nine diferenl state hospitals in Turkey and were confirmed as A.baumannU by conventional biochemical,API testing and bla_(-OXA-51)specific PCR.The isolates were examined by PCR for existence of class I and2 integron gene cassettes.Results:They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin(90.03%),ciprofloxacin(87.54%),cefepime and trimethoprim/sulfamethoxazole(81.13%).The lowest resistance rates was for cefotaxime(3.55%).class 1 integrons were detected in 6.4%(18/281)of A.baumannii strains and no class 2 integron was detected.The gene casselles of class 1 inlegrons AacCI-AAC(3)l-aadAI,AacCI-aadA1,AAC(3)-I,AAC(3)-I-AAC(3)-I-aadA1,TEM-1.AAC(3)-I-aadA1-AAC(3)-I-AAC(3)-I,AAC(3)-I-AAC(3)-I-AAC(3)-I-aadA1,AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I,AAC(3)-I-aadA1-AAC(3)-I-aadA1,AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains.The aac genes family were most frequently found integrated into the class 1 inlegrons and it was followed by aadA genes and TEM-1 genes.Conclusions:This is an extensive study on the distribulion of class 1 integron among A.baumannii in Turkey.In addition to these,two new alleles were observed.Their percentage rates of similarity to other cassettes are 95%aadA1(TK A18)and 89%,aadA 1(ANKA3).
文摘Acinetobacter baumannii is a major cause of nosocomial infections worldwide. By summarizing the epidemiology, molecular and drug resistance mechanisms, diagnosis and treatment strategies of Acinetobacter baumannii, the clinical outcome is finally improved.
基金supported by a from grant Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)
文摘BACKGROUND:The Acinetobacter baumannii group,including Acinetobacter baumannii,Acinetobacter genomospecies 3 and 13 TU,is phenotypically indistinguishable and uniformly identified as Acinetobacter baumannii by laboratories of clinical microbiology.This review aimed to demonstrate the differences among them.METHODS:Literatures associated with the Acinetobacter baumannii group were identified and selected from PubMed databases and relevant journals.RESULTS:Acinetobacter genospecies 3 and 13 TU possess a certain proportion in clinical isolates.There were considerable differences in epidemiologic features,clinical manifestations,antimicrobial resistances and therapeutic options among the Acinetobacter baumannii group.Compared with Acinetobacter genomospecies 3 and 13 TU,Acinetobacter baumannii with a higher resistance to antimicrobial agents are easier to be treated inappropriately,and present a worse outcome in patients.CONCLUSION:The Acinetobacter baumannii group comprises three distinct clinical entities,and their clinical value are not equal.
基金the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-12M-1-003)。
文摘BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.
文摘BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.
文摘IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock. As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.
文摘AIM: To describe the intensive care unit(ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii(AB) infection.METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico(INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23(4.6%) of whom developed AB infections. Sixteen(60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock(56.2%) and postoperative care(21.7%). The respiratory tract was the most frequent site of AB infection(91.3%). The most common organ dysfunction observed in our group of patients were the respiratory(100%), cardiovascular(100%), hepatic(73.9%) and renal dysfunction(65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7%(2/17) compared with 66.6%(4/6) for the group of patients with 4 or more organ system dysfunctions(P = 0.021). Multivariate analysis identified blood lactate levels(BLL) as the only variable independently associated with inICU death(OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.
