Jiahao Guan,1,* Zitong Wang,1,2,* Yihan Dong,1,2 Jun Wang,3 Yajuan Ren,4 Zifan Lu,5 Shuling Hu,1 Xianglong Duan6 

1Department of Clinical Laboratory, Shaanxi Provincial People′s Hospital, Xi ′an, People’s Republic of China; 2Medical College, Yan’ an University, Yan’ an, People’s Republic of China; 3Department of Respiratory MedicineI, Shaanxi Provincial People’s Hospital, Xi ′an, People’s Republic of China; 4Department of Respiratory Medicine II, Shaanxi Provincial People’s Hospital, Xi ′an, People’s Republic of China; 5Translational medicine Center, Shaanxi Provincial People’s Hospital, Xi ′an, People’s Republic of China; 6Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi ′an, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xianglong Duan, Second Department of General Surgery, Shaanxi Provincial People′s Hospital, No. 256, Youyi West Road, Xi’an, Shaanxi, 710068, People’s Republic of China, Tel +86 029-85251331, Email duanxianglong@nwpu.edu.cn

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) infections, particularly among respiratory patients, are associated with high mortality rates and substantial healthcare costs, exceeding $1.2 billion annually. Current the medications are recommended therapies, including Colistin and Tigecycline, face significant limitations, such as nephrotoxicity and inadequate lung tissue penetration. In contrast, Eravacycline (ERV), a novel fluorocycline, exhibits potent activity against multidrug-resistant Gram-negative pathogens and may help mitigate these limitations.
Patients and Methods: A retrospective analysis was conducted on 1071 CRAB isolates obtained from 524 respiratory patients at Shaanxi Provincial People’s Hospital in 2024. Bacterial identification was performed using mass spectrometry (Zhongyuan Co). while drug susceptibility testing was carried out using the BD Phoenix M50 (Becton Dickinson) and E-test strips (Liofilchem). Multivariable logistic regression was applied to identify independent risk factors, including age, intubation history, comorbidities, and the use of feeding tubes, with adjusted odds ratios (OR), 95% confidence intervals (CI), and P-values reported.
Results: Tracheal intubation emerged as the strongest independent risk factor for CRAB acquisition (OR=3.325, 95% CI: 2.273– 4.865, P< 0.001). Resistance to β-lactam antibiotics exceeded 96% (Ceftazidime: 96.56%, Ceftriaxone: 97.14%). C-reactive Protein (CRP) (OR=1.001, 95% CI: 0.996– 1.006, P=0.004) and interleukin-6 (IL-6) (P< 0.001) independently predicted mortality, with SAA demonstrating a strong association with risk (OR = 1.001, 95% CI: 0.999– 1.002, P = 0.006).
Conclusion: Endotracheal intubation significantly contributes to the transmission of CRAB, underscoring the necessity for employing early respiratory ventilation and ERV as a recommended therapies therapeutic strategy in environments with elevated β-lactam resistance. Serum amyloid A (SAA) and interleukin-6 (IL-6) are important prognostic biomarkers that facilitate risk stratification. The implementation of infection control measures that prioritize intubation-associated practices is essential for alleviating the burden of CRAB infections.

Keywords: eravacycline, carbapenem-resistant Acinetobacter baumannii, multidrug resistance, hospital-acquired infections, respiratory diseases, biomarkers