Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes.
We conducted a retrospective matched cohort study to examine the impact of isolation of multi-drug-resistant (MDR) Acinetobacter baumannii on patient outcomes. Cases from whom MDR A. baumannii was isolated in a clinical culture (n = 118) were compared with controls from whom MDR A. baumannii was not isolated (n = 118). Cases and controls were matched according to ward, calendar month of hospitalization, and duration of hospitalization before culture. The following outcomes were compared in multivariable analysis: in-hospital mortality, length of stay, need for mechanical ventilation, and functional status at discharge. MDR A. baumannii was determined to be a pathogen in 72% of cases. In 36% of cases, the patient died, versus 21% of controls (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.17-4.16, P = 0.014). Median length of stay for surviving cases was 17 days, versus 11 for surviving controls (multiplicative effect 1.55, 95% CI 0.99-2.44, P = 0.057). Fifty-two percent of cases required mechanical ventilation, versus 25% of controls (OR 3.72, 95% CI 1.91-7.25, P<0.001); 60% of surviving cases were discharged with reduced functional status, versus 38% of controls (OR 4.4, 95% CI 1.66-11.61, P = 0.003). In multivariable analysis, clinical isolation of MDR A. baumannii remained a significant predictor of mortality (OR 6.23, 95% CI 1.31-29.5, P = 0.021), need for mechanical ventilation (OR 7.34, 95% CI 2.24-24.0, P<0.001), and reduced functional status on discharge (OR 7.93, 95% CI 1.1-56.85, P = 0.039). Thus, MDR A. baumannii acquisition is associated with severe adverse outcomes, including increased mortality, need for mechanical ventilation, and reduced functional status.
Abbo
A
A
Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.
Carmeli
Y
Y
Navon-Venezia
S
S
Siegman-Igra
Y
Y
Schwaber
M J
MJ
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000368:Aged; D016022:Case-Control Studies; D003243:Consciousness; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome
J Infect Dis. 2006 Jun 1;193(11):1495-503
16652276
J Hosp Infect. 2006 Sep;64(1):7-15
16822583
Clin Infect Dis. 2004 Jul 1;39(1):31-7
15206050
Emerg Infect Dis. 2007 Jan;13(1):97-103
17370521
Antimicrob Agents Chemother. 2006 Sep;50(9):3179-82
16940124
Crit Care. 2006;10(5):164
16982010
Clin Infect Dis. 1996 Jun;22(6):1026-32
8783704
Crit Care. 2006;10(2):R48
16563184
Arch Intern Med. 2002 Jul 8;162(13):1515-20
12090889
Medicine (Baltimore). 1995 Nov;74(6):340-9
7500897
Clin Infect Dis. 2001 May 15;32 Suppl 2:S104-13
11320451
Curr Opin Infect Dis. 2005 Aug;18(4):306-13
15985826
Clin Infect Dis. 1999 Jan;28(1):59-66
10028073
Lancet. 1994 Nov 12;344(8933):1329-32
7968028
J Clin Microbiol. 1997 Jun;35(6):1394-7
9163451
PLoS Genet. 2006 Jan;2(1):e7
16415984
Clin Infect Dis. 1997 Jan;24 Suppl 1:S17-8
8994777
Am J Epidemiol. 1990 Oct;132(4):723-33
2403113
Emerg Infect Dis. 2002 Aug;8(8):802-7
12141965
Antimicrob Agents Chemother. 2006 Apr;50(4):1257-62
16569837
J Clin Microbiol. 2000 Nov;38(11):4086-95
11060073
J Hosp Infect. 2005 Jul;60(3):256-60
15893851
Emerg Infect Dis. 2004 Jun;10(6):1125-8
15207068
Am J Infect Control. 1988 Jun;16(3):128-40
2841893
Clin Infect Dis. 2006 Mar 1;42(5):692-9
16447117
MMWR Morb Mortal Wkly Rep. 2004 Nov 19;53(45):1063-6
15549020
J Antimicrob Chemother. 2006 Jun;57(6):1251-4
16627593
Emerg Infect Dis. 2005 Jan;11(1):22-9
15705318
Arch Intern Med. 1999 May 24;159(10):1127-32
10335691
Crit Care Med. 2005 May;33(5):1136-40
15891349
J Hosp Infect. 2002 May;51(1):47-51
12009820
Science. 1992 Aug 21;257(5073):1050-5
1509255
Emerg Infect Dis. 2005 Aug;11(8):1218-24
16102310
Intensive Care Med. 2003 Mar;29(3):471-5
12577148
Neurosurgery. 1987 Apr;20(4):610-6
3587555
Am J Med. 2003 Nov;115(7):529-35
14599631
Am J Infect Control. 1996 Oct;24(5):380-8
8902113
Antimicrob Agents Chemother. 2004 Sep;48(9):3477-82
15328114
Infect Control Hosp Epidemiol. 1989 Sep;10(9):402-7
2794465
Clin Infect Dis. 2006 Aug 1;43(3):389; author reply 389-90
16804863