title: Risk factors of multidrug resistance in nosocomial bacteremia due to Acinetobacter baumannii: a case-control study.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138 Sheng Li Road, Tainan, Taiwan.
authors.forename: Mu-Jen
authors.initials: MJ
authors.lastname: Shih
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Po-Ling
authors.initials: PL
authors.lastname: Chen
authors.forename: Nai-Ying
authors.initials: NY
authors.lastname: Ko
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: 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