title: Attributable mortality of nosocomial Acinetobacter bacteremia.
abstract: OBJECTIVE
  To determine the attributable mortality and outcome of nosocomial Acinetobacter bacteremia.
  
  
  METHODS
  Matched, retrospective cohort study.
  
  
  METHODS
  Large, university-based, tertiary care center.
  
  
  METHODS
  Of 219 patients with nosocomial Acinetobacter bacteremia identified by prospective surveillance during a 3-year period, 52 met the criteria for the study and were matched to a control patient by age, sex, primary and secondary diagnosis, operative procedures, and date of admission.
  
  
  RESULTS
  A 100% success rate was achieved in the proportion of case patients and control patients matched for the compared criteria, except for major operative procedures (88%) and the presence of an important secondary underlying disease (54.5%). Twenty-nine (55.7%) of the case patients died, compared with 10 (19.2%) of the control patients (P<.001). The attributable mortality was 36.5% (95% CI, 27%-46%) and the risk ratio for death was 2.9 (95% CI, 1.58-5.32). In a multivariate survival analysis, older age, mechanical ventilation, renal failure, and Acinetobacter bacteremia (hazard ratio [HR], 4.41; 95% confidence interval [CI], 1.97-9.87; P<.001) were found to be independent predictors of mortality. There was a trend for a longer median duration of hospitalization among case patients, compared with control patients (11.5 vs. 6.5 days; P=.06). Three isolates were resistant to all but 1 antibiotic tested (colistin), and 45 isolates (86.5%) were resistant to 4 or more different antibiotic classes.
  
  
  CONCLUSIONS
  When adjusted for risk-exposure time and severity of disease at admission, nosocomial Acinetobacter bacteremia is associated with mortality in excess of that caused by the underlying diseases alone.
authors.affiliation: Infectious Diseases Unit, Rambam Medical Center, 31096-Bat Galim, Haifa, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Grupper
authors.forename: Hanna
authors.initials: H
authors.lastname: Sprecher
authors.forename: Tania
authors.initials: T
authors.lastname: Mashiach
authors.forename: Renato
authors.initials: R
authors.lastname: Finkelstein
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification*; D000151:Acinetobacter Infections / Q000382:microbiology / Q000401:mortality*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D016022:Case-Control Studies; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D024881:Drug Resistance, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents