title: Attributable mortality of imipenem-resistant nosocomial Acinetobacter baumannii bloodstream infection.
abstract: BACKGROUND
  Uncertainty remains concerning the mortality attributable to infections caused by imipenem-resistant acinetobacter baumannii (IRAB). The authors have sought to examine the impact of this resistance on patient mortality.
  
  
  OBJECTIVE
  To evaluate the effects of imipenem resistance on the mortality of patients with Acinetobacter baumannii bloodstream infection.
  
  
  METHODS
  A cohort study was conducted to compare the survival rates between patients with IRAB and imipenem-susceptible A. baumannii (ISAB) bacteremia.
  
  
  RESULTS
  The present study shows 35 patients (52.2%) in an IRAB group died in hospital compared to 26 patients (19.9%) in an ISAB group (p < 0.001). Multivariate analysis using Cox's proportional hazard model for controlling the confounding effects due to the severity of underlying diseases, inappropriate antibiotic treatment, and primary source of bacteremia show no statistically significant difference in mortality rates between the two groups.
  
  
  CONCLUSIONS
  The observed higher mortality rate among patients with an IRAB bloodstream infection may not be attributable to imipenem resistance but may in some part be due to a more severe illness, inappropriate antimicrobial therapy, and primary source of infection.
authors.affiliation: Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. jsilom@medicine.psu.ac.th
authors.forename: Silom
authors.initials: S
authors.lastname: Jamulitrat
authors.forename: Pranee
authors.initials: P
authors.lastname: Arunpan
authors.forename: Parichart
authors.initials: P
authors.lastname: Phainuphong
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D017052:Hospital Mortality; D006801:Humans; D015378:Imipenem / Q000494:pharmacology* / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D013785:Thailand
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem