title: Predictors of mortality in Acinetobacter baumannii bacteremia.
abstract: 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.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hsin Pai
authors.initials: HP
authors.lastname: Chen
authors.forename: Te Li
authors.initials: TL
authors.lastname: Chen
authors.forename: Chung Hsu
authors.initials: CH
authors.lastname: Lai
authors.forename: Chang Phone
authors.initials: CP
authors.lastname: Fung
authors.forename: Wing Wai
authors.initials: WW
authors.lastname: Wong
authors.forename: Kwok Woon
authors.initials: KW
authors.lastname: Yu
authors.forename: Cheng Yi
authors.initials: CY
authors.lastname: Liu
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D012709:Serum Albumin