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Research article
Yucai Zhang
Shanghai Children's Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4905-3600
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients.
Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Acinetobacter baumannii clinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records.
Results 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while the Acinetobacter baumannii -associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2%±3.61% vs. 9.15%±6.21%, P =0.029), higher CD4+ T cell ratio (39.67%±12.18% vs. 32.66%±11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/ml vs. 0.1 (0.1, 22.99)pg/ml, P=0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890-0.981；P=0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425-870.574; p= 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients.
Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
Keywords
MDR/XDR, Acinetobacter baumannii, Risk Factors, Mortality, Pediatric Intensive Care Units
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Editor assigned
On 30 Jul, 2020
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On 29 Jul, 2020
Editorial decision: Accept
On 29 Jul, 2020
Editor invited
On 29 Jul, 2020
Version 4
Posted 19 Jul, 2020
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Review #2 received
Received 19 Jul, 2020
Review #1 received
Received 18 Jul, 2020
Reviewer #1 agreed
On 15 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Editor assigned
On 14 Jul, 2020
Reviewers invited
Invitations sent on 14 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
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Editorial decision: Minor revision
On 01 Jul, 2020
Review #2 received
Received 29 Jun, 2020
Reviewer #2 agreed
On 26 Jun, 2020
Review #1 received
Received 25 Jun, 2020
Reviewers invited
Invitations sent on 23 Jun, 2020
Reviewer #1 agreed
On 23 Jun, 2020
Editor assigned
On 22 Jun, 2020
Submission checks complete
On 21 Jun, 2020
Editor invited
On 21 Jun, 2020
No comments provided
Editorial decision: Major revision
On 09 May, 2020
Review #2 received
Received 08 Apr, 2020
Review #1 received
Received 08 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Reviewer #2 agreed
On 06 Apr, 2020
Reviewer #3 agreed
On 06 Apr, 2020
Reviewers invited
Invitations sent on 01 Apr, 2020
Editor assigned
On 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
No comments provided
Editorial decision: Major revision
On 02 Mar, 2020
Review #1 received
Received 13 Jan, 2020
Reviewer #1 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 25 Dec, 2019
Editor assigned
On 19 Dec, 2019
First submitted
On 18 Dec, 2019
Submission checks complete
On 18 Dec, 2019
Editor invited
On 18 Dec, 2019
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yucai Zhang
Shanghai Children's Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4905-3600
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Editor assigned
On 30 Jul, 2020
Submission checks complete
On 29 Jul, 2020
Editorial decision: Accept
On 29 Jul, 2020
Editor invited
On 29 Jul, 2020
Version 4
Posted 19 Jul, 2020
No comments provided
Review #2 received
Received 19 Jul, 2020
Review #1 received
Received 18 Jul, 2020
Reviewer #1 agreed
On 15 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Editor assigned
On 14 Jul, 2020
Reviewers invited
Invitations sent on 14 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 01 Jul, 2020
Review #2 received
Received 29 Jun, 2020
Reviewer #2 agreed
On 26 Jun, 2020
Review #1 received
Received 25 Jun, 2020
Reviewers invited
Invitations sent on 23 Jun, 2020
Reviewer #1 agreed
On 23 Jun, 2020
Editor assigned
On 22 Jun, 2020
Submission checks complete
On 21 Jun, 2020
Editor invited
On 21 Jun, 2020
No comments provided
Editorial decision: Major revision
On 09 May, 2020
Review #2 received
Received 08 Apr, 2020
Review #1 received
Received 08 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Reviewer #2 agreed
On 06 Apr, 2020
Reviewer #3 agreed
On 06 Apr, 2020
Reviewers invited
Invitations sent on 01 Apr, 2020
Editor assigned
On 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
No comments provided
Editorial decision: Major revision
On 02 Mar, 2020
Review #1 received
Received 13 Jan, 2020
Reviewer #1 agreed
On 26 Dec, 2019
Reviewers invited
Invitations sent on 25 Dec, 2019
Editor assigned
On 19 Dec, 2019
First submitted
On 18 Dec, 2019
Submission checks complete
On 18 Dec, 2019
Editor invited
On 18 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients.
Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Acinetobacter baumannii clinical isolates were recovered from different specimens including blood, sputum, bronchoalveolar lavage fluid, cerebrospinal fluid, ascites, hydrothorax, and urine. Antibiotic susceptibility test was determined according to the Clinical and Laboratory Standards Institute interpretive criteria. Clinical and biological data were obtained from the patients’ medical records.
Results 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 male in the case group. The overall mortality rate was 29.4%, while the Acinetobacter baumannii -associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2%±3.61% vs. 9.15%±6.21%, P =0.029), higher CD4+ T cell ratio (39.67%±12.18% vs. 32.66%±11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/ml vs. 0.1 (0.1, 22.99)pg/ml, P=0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890-0.981；P=0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425-870.574; p= 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients.
Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality. Bloodstream and central nervous infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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