Multidrug-resistant Acinetobacter spp. bloodstream infections in hematologic patients: clinical characteristics, genomic features, and eravacycline-based combination therapy
Abstract
BACKGROUND: Multidrug-resistant (MDR) Acinetobacter spp. bloodstream infection (BSI) is concerning in hematologic patients, but integrated clinical and genomic analyses are scarce.
METHODS: We retrospectively analyzed 62 hematologic patients with Acinetobacter spp. BSI over 13 years, including 30 MDR and 32 non-MDR cases. Whole-genome sequence (WGS) was conducted on 23 MDR isolates. Checkerboard assays evaluated the in vitro activity of eravacycline combined with sulbactam, meropenem, cefoperazone-sulbactam, polymyxin B, and levofloxacin.
RESULTS: Female (66.67% vs. 34.38%, P = 0.022) and adult (≥ 14 years; 80.00% vs. 53.12%, P = 0.049) patients were more common in the MDR group. Prior carbapenem exposure, prolonged neutropenia, and respiratory tract colonization were associated with MDR-BSI. The majority of MDR cases did not receive appropriate empirical therapy within 24 h (40.00% vs. 90.62%, P < 0.001). The overall 30-day mortality was 38.71%, significantly higher in MDR than non-MDR patients (53.33% vs. 25.00%, P = 0.043). Among MDR subgroup, 30-day non-survivors had more profound cytopenias and higher inflammatory markers at BSI onset (P < 0.05). WGS revealed diverse sequence types and capsular loci across the isolates, including 14 non-A.baumannii and 9 A.baumannii strains. Among 20 carbapenemase-positive isolates, blaOXA-23 (n = 9) predominated in A.baumannii, while blaOXA-58 (n = 7) and blaNDM-1 (n = 7) were restricted to non-A.baumannii isolates. Eravacycline…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 62 participants or records.
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