Predictors of mortality in Acinetobacter baumannii bacteremia.
This study retrospectively investigated 149 episodes of Acinetobacter baumannii bacteremia which occurred during a 41-month period from September 1997 to January 2001. Bacteremia was nosocomial in 139 (93%) of the episodes and community-acquired in 10 (7%). Thirty three deaths (22.1%) were attributed to these episodes of A. baumannii bacteremia. The mean age of survivors was younger than that of patients who died of bacteremia (60.4 +/- 19.9 vs 67.1 +/- 17.4) but this result was not significant on univariate analysis (p=0.084). Previous intensive care unit stay was longer among survivors than among patients who died of bacteremia (9.5 vs 18 days, p=0.048). Factors associated with mortality included immunosuppression (p=0.019), shock (p=0.002), recent surgery (p=0.008), invasive procedures such as central venous catheterization (p=0.002), urinary catheterization (p=0.012), placement of a nasogastric tube (p<0.001), pulmonary catheterization (p=0.015), and mechanical ventilation (p=0.035). The number of underlying conditions (p=0.015) and invasive procedures (p<0.001) were positively correlated with mortality. Mortality was significantly associated with lower platelet count (p=0.001) and lower serum albumin concentration (p=0.005). Patients with catheter-related bacteremia had a high survival rate (96.2%), while survival rate was low in patients with infection originating from the respiratory tract (60.8%). Susceptibility testing by agar dilution test indicated that imipenem was the most effective antibiotic, followed by cefepime and ciprofloxacin. The mortality rate was lower in patients who received 1 or more antibiotics to which the isolates were susceptible, but this difference was not significant (p=0.197). On multivariate analysis, factors that independently correlated with mortality were increased age (p=0.003), immunosuppressive status (p=0.001), recent surgery (p=0.002), acute respiratory failure (p=0.004), acute renal failure (p=0.009) and septic shock (p<0.001). These findings highlight the importance of a treatment strategy based on risk stratification among patients with A. baumannii bacteremia.
Chen
Hsin Pai
HP
Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Chen
Te Li
TL
Lai
Chung Hsu
CH
Fung
Chang Phone
CP
Wong
Wing Wai
WW
Yu
Kwok Woon
KW
Liu
Cheng Yi
CY
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality*; D002404:Catheterization; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010976:Platelet Count; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D012769:Shock; D013514:Surgical Procedures, Operative; D013624:Taiwan / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D012709:Serum Albumin