Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis.
To identify risk factors for and prognostic indicators of the nosocomial acquisition of multiresistant Acinetobacter baumannii in an intensive care unit, we prospectively studied 40 patients: 13 who were infected with this organism and 27 who were colonized. Isolates were identified by pulsed-field gel electrophoresis; the infected/colonized patients were compared with 348 noninfected, noncolonized patients by logistic regression analysis and with matched historical controls in a cohort study. The severity of illness (evaluated by the APACHE II score; P < .05) and previous infection (P < .001) were retained as independent risk factors for acquiring A. baumannii. Logistic regression analysis selected a high APACHE II score (P < .01) and the acquisition of A. baumannii (P < .01) as factors independently associated with death. The acquisition of A. baumannii was associated not only with high mortality but also with a length of stay on the intensive care unit in excess of that due to the underlying disease alone; specifically, the attributable mortality was 25%, with a risk ratio for death of 2.0 (95% confidence interval, 1.11-3.62), and the duration of stay for infected/colonized patients was 10.3 days longer than that for controls (P < .001).
Lortholary
O
O
Service de Médecine Interne, Université Paris Nord, Bobigny, France.
Fagon
J Y
JY
Hoi
A B
AB
Slama
M A
MA
Pierre
J
J
Giral
P
P
Rosenzweig
R
R
Gutmann
L
L
Safar
M
M
Acar
J
J
D018806:APACHE; D000150:Acinetobacter / Q000187:drug effects*; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors