Risk factors of multidrug resistance in nosocomial bacteremia due to Acinetobacter baumannii: a case-control study.
OBJECTIVE
Acinetobacter baumannii is an important nosocomial pathogen. Bacteremia caused by multidrug-resistant A. baumannii (MDRAB) leads to higher mortality and medical cost compared with non-MDRAB bacteremia. We aimed to identify risk factors of multidrug resistance in A. baumannii bacteremia.


METHODS
A matched case-control study was conducted to compare the differences in risk factors of patients with MDRAB and non-MDRAB bacteremia.


RESULTS
Sixty three patients with MDRAB bacteremia and 63 matched patients with non-MDRAB bacteremia were identified from hospital and laboratory records of the period 1996 to 2002. Multivariate logistic regression analysis identified four independent risk factors associated with multidrug resistance in A. baumannii bacteremic patients: previous colonization with A. baumannii (odds ratio [OR], 7.99; 95% confidence interval [CI], 2.1-30.6; p=0.002), antecedent antimicrobial therapy (OR, 6.10; 95% CI, 1.2-29.9; p=0.026) the number of recently prescribed antibiotics (OR 1.35; 95% CI, 1.0-1.8; p=0.026), and recent invasive procedures (OR, 4.17; 95% CI, 1.6-11.1; p=0.004).


CONCLUSIONS
Overall, patients with MDRAB bacteremia had earlier A. baumannii colonization, greater previous exposure to antimicrobial agents and recent invasive procedures. The results of this study demonstrate a rationale for the development of effective interventions to minimize the impact of MDRAB.
Shih
Mu-Jen
MJ
Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138 Sheng Li Road, Tainan, Taiwan.
Lee
Nan-Yao
NY
Lee
Hsin-Chun
HC
Chang
Chia-Ming
CM
Wu
Chi-Jung
CJ
Chen
Po-Ling
PL
Ko
Nai-Ying
NY
Ko
Wen-Chien
WC
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors