{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:32:52Z","timestamp":1791545572599,"version":"4.3.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010425","name":"Tri-Service General Hospital","doi-asserted-by":"publisher","award":["TSGH-E-109237, TSGH-E-110205, TSGH-E-111245"],"award-info":[{"award-number":["TSGH-E-109237, TSGH-E-110205, TSGH-E-111245"]}],"id":[{"id":"10.13039\/501100010425","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST-108-2314-B-016 -029, MOST-109-2314-B-016 -056, MOST-110-2314-B-016 -063, MOST-110-2314-B-075-072, MOST 108-2314-B-075-034-MY3, MOST 107-2314-B-075-066-MY3"],"award-info":[{"award-number":["MOST-108-2314-B-016 -029, MOST-109-2314-B-016 -056, MOST-110-2314-B-016 -063, MOST-110-2314-B-075-072, MOST 108-2314-B-075-034-MY3, MOST 107-2314-B-075-066-MY3"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V108C-012, VTA108-T-2-3, VTA109-T-3-2, VTA110-V4-5-2, VTA111-T-3-3"],"award-info":[{"award-number":["V108C-012, VTA108-T-2-3, VTA109-T-3-2, VTA110-V4-5-2, VTA111-T-3-3"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>In the past decades, due to the high prevalence of the antibiotic-resistant isolates of <jats:italic>Acinetobacter baumannii<\/jats:italic>, it has emerged as one of the most troublesome pathogens threatening the global healthcare system. Furthermore, this pathogen has the ability to form biofilms, which is another effective mechanism by which it survives in the presence of antibiotics. However, the clinical impact of biofilm-forming <jats:italic>A. baumannii<\/jats:italic> isolates on patients with bacteremia is largely unknown. This retrospective study was conducted at five medical centers in Taiwan over a 9-year period. A total of 252 and 459 patients with bacteremia caused by biofilm- and non-biofilm-forming isolates of <jats:italic>A. baumannii<\/jats:italic>, respectively, were enrolled. The clinical demographics, antimicrobial susceptibility, biofilm-forming ability, and patient clinical outcomes were analyzed. The biofilm-forming ability of the isolates was assessed using a microtiter plate assay. Multivariate analysis revealed the higher APACHE II score, shock status, lack of appropriate antimicrobial therapy, and carbapenem resistance of the infected strain were independent risk factors of 28-day mortality in the patients with <jats:italic>A. baumannii<\/jats:italic> bacteremia. However, there was no significant difference between the 28-day survival and non-survival groups, in terms of the biofilm forming ability. Compared to the patients infected with non-biofilm-forming isolates, those infected with biofilm-forming isolates had a lower in-hospital mortality rate. Patients with either congestive heart failure, underlying hematological malignancy, or chemotherapy recipients were more likely to become infected with the biofilm-forming isolates. Multivariate analysis showed congestive heart failure was an independent risk factor of infection with biofilm-forming isolates, while those with arterial lines tended to be infected with non-biofilm-forming isolates. There were no significant differences in the sources of infection between the biofilm-forming and non-biofilm-forming isolate groups. Carbapenem susceptibility was also similar between these groups. In conclusion, the patients infected with the biofilm-forming isolates of the <jats:italic>A. baumannii<\/jats:italic> exhibited different clinical features than those infected with non-biofilm-forming isolates. The biofilm-forming ability of <jats:italic>A. baumannii<\/jats:italic> may also influence the antibiotic susceptibility of its isolates. However, it was not an independent risk factor for a 28-day mortality in the patients with bacteremia.<\/jats:p>","DOI":"10.3389\/fcimb.2022.964539","type":"journal-article","created":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T05:56:52Z","timestamp":1663307812000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Biofilm formation is not an independent risk factor for mortality in patients with Acinetobacter baumannii bacteremia"],"prefix":"10.3389","volume":"12","author":[{"given":"Tsung-Ta","family":"Chiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu-Wen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Ren","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Chen","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristine","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Pan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuag-Meng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Sung","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Te-Li","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Tzu","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Chih","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"DC08","DOI":"10.7860\/JCDR\/2015\/11014.5398","article-title":"Biofilm producing multidrug resistant acinetobacter baumannii: An emerging challenge","volume":"9","author":"Badave","year":"2015","journal-title":"J. Clin. Diagn. Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/s12879-015-0972-2","article-title":"Clinical infectious outcomes associated with biofilm-related bacterial infections: a retrospective chart review","volume":"15","author":"Barsoumian","year":"2015","journal-title":"BMC Infect. Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1111\/j.1469-0691.2007.01744.x","article-title":"Comparison of one-tube multiplex PCR, automated ribotyping and intergenic spacer (ITS) sequencing for rapid identification of Acinetobacter baumannii. clin","volume":"13","author":"Chen","year":"2007","journal-title":"Microbiol. Infect."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1093\/clinids\/22.6.1026","article-title":"Bacteremia due to acinetobacter baumannii: epidemiology, clinical findings, and prognostic features","volume":"22","author":"Cisneros","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"B5","volume-title":"Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: Approved standard M7-A7","year":"2006"},{"key":"B6","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing. 30th Ed. CLSI Supplement M100","year":"2020"},{"key":"B7","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1080\/14787210.2018.1417036","article-title":"Biofilm-related disease","volume":"16","author":"Del Pozo","year":"2018","journal-title":"Expert Rev. Anti-Infect Ther."},{"key":"B8","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1038\/nrmicro1789","article-title":"An increasing threat in hospitals: multidrug-resistant acinetobacter baumannii","volume":"5","author":"Dijkshoorn","year":"2007","journal-title":"Nat. Rev. Microbiol."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9112384","article-title":"Relationship between the biofilm-forming capacity and antimicrobial resistance in clinical acinetobacter baumannii isolates: results from a laboratory-based in vitro study","volume":"9","author":"Donadu","year":"2021","journal-title":"Microorganisms"},{"key":"B10","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/0196-6553(88)90053-3","article-title":"CDC Definitions for nosocomial infections, 1988","volume":"16","author":"Garner","year":"1988","journal-title":"Am. J. Infect. Control."},{"key":"B11","doi-asserted-by":"publisher","first-page":"3711","DOI":"10.2147\/IDR.S332051","article-title":"Acinetobacter baumannii biofilm formation and its role in disease pathogenesis: A review","volume":"14","author":"Gedefie","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"B12","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.ijantimicag.2009.12.011","article-title":"Antibiotic resistance of bacterial biofilms","volume":"35","author":"H\u00f8iby","year":"2010","journal-title":"Int. J. Antimicrob. Agents."},{"key":"B13","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.cmi.2014.10.024","article-title":"ESCMID guideline for the diagnosis and treatment of biofilm infections 2014","author":"H\u00f8iby","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"B14","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.cmi.2014.10.024","article-title":"ESCMID guideline for the diagnosis and treatment of biofilm infections 2014","volume":"21","author":"H\u00f8iby","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"B15","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1038\/nrmicro821","article-title":"Bacterial biofilms: from the natural environment to infectious diseases","volume":"2","author":"Hall-Stoodley","year":"2004","journal-title":"Nat. Rev. Microbiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1038\/nrmicro1774","article-title":"Multimetal resistance and tolerance in microbial biofilms","volume":"5","author":"Harrison","year":"2007","journal-title":"Nat. Rev. Microbiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.ijantimicag.2007.06.026","article-title":"Exposure to quinolones is associated with carbapenem resistance among colistin-susceptible acinetobacter baumannii blood isolates","volume":"30","author":"Kopterides","year":"2007","journal-title":"Int. J. Antimicrob. Agents."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.micres.2022.127032","article-title":"The role of quorum sensing, biofilm formation, and iron acquisition as key virulence mechanisms in acinetobacter baumannii and the corresponding anti-virulence strategies","volume":"260","author":"Law","year":"2022","journal-title":"Microbiol. Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1093\/cid\/cis385","article-title":"Impact of appropriate antimicrobial therapy on mortality associated with acinetobacter baumannii bacteremia: Relation to severity of infection","volume":"55","author":"Lee","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1128\/AAC.45.4.999-1007.2001","article-title":"Riddle of biofilm resistance","volume":"45","author":"Lewis","year":"2001","journal-title":"Antimicrob. Agents Chemother."},{"key":"B21","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.jmii.2018.03.001","article-title":"A multicenter study on clinical characteristics of acinetobacter bacteremia in patients with liver cirrhosis","volume":"52","author":"Liu","year":"2019","journal-title":"J. Microbiol. Immunol. Infect. Wei mian yu gan ran za zhi."},{"key":"B22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/s0966-842x(00)01913-2","article-title":"Mechanisms of biofilm resistance to antimicrobial agents","volume":"9","author":"Mah","year":"2001","journal-title":"Trends Microbiol."},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-4-5","article-title":"Biofilm formation at the solid\u2013liquid and air\u2013liquid interfaces by acinetobacter species","volume":"4","author":"Mart\u00ed","year":"2011","journal-title":"BMC Res. Notes."},{"key":"B24","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1007\/s10096-015-2323-z","article-title":"Biofilm-specific antibiotic tolerance and resistance","volume":"34","author":"Olsen","year":"2015","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/s0076-6879(99)10008-9","article-title":"Genetic approaches to study of biofilms","volume":"310","author":"O\u2019Toole","year":"1999","journal-title":"Methods Enzymol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1128\/CMR.00058-07","article-title":"Acinetobacter baumannii: emergence of a successful pathogen","volume":"21","author":"Peleg","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2016.00483","article-title":"Relationship between antibiotic resistance, biofilm formation, and biofilm-specific resistance in acinetobacter baumannii","volume":"7","author":"Qi","year":"2016","journal-title":"Front. Microbiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"333","DOI":"10.4103\/0255-0857.43566","article-title":"Correlation between biofilm production and multiple drug resistance in imipenem resistant clinical isolates of acinetobacter baumannii","volume":"26","author":"Rao","year":"2008","journal-title":"Indian J. Med. Microbiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1111\/j.1469-0691.2007.01916.x","article-title":"Biofilm formation in acinetobacter baumannii: Associated features and clinical implications","volume":"14","author":"Rodr\u00edguez-Ba\u00f1o","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"B30","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1086\/502205","article-title":"Acinetobacter outbreaks, 1977\u20132000","volume":"24","author":"Villegas","year":"2003","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"7289","DOI":"10.1038\/s41598-018-25661-9","article-title":"Biofilm formation is not associated with worse outcome in acinetobacter baumannii bacteraemic pneumonia","volume":"8","author":"Wang","year":"2018","journal-title":"Sci. Rep."},{"key":"B32","doi-asserted-by":"publisher","first-page":"4670","DOI":"10.1128\/AAC.00551-16","article-title":"Individual or combined effects of meropenem, imipenem, sulbactam, colistin, and tigecycline on biofilm-embedded acinetobacter baumannii and biofilm architecture","volume":"60","author":"Wang","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"B33","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1128\/CMR.00058-16","article-title":"Clinical and pathophysiological overview of Acinetobacter infections: a century of challenges","volume":"30","author":"Wong","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"B34","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s10238-014-0333-2","article-title":"Biological features of biofilm-forming ability of acinetobacter baumannii strains derived from 121 elderly patients with hospital-acquired pneumonia","volume":"16","author":"Zhang","year":"2016","journal-title":"Clin. Exp. Med."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.964539\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T05:57:00Z","timestamp":1663307820000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2022.964539\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,16]]},"references-count":34,"alternative-id":["10.3389\/fcimb.2022.964539"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2022.964539","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,16]]},"article-number":"964539"}}