Carbapenem-resistant versus carbapenem-susceptible Acinetobacter baumannii bacteremia in a Greek intensive care unit: risk factors, clinical features and outcomes.
BACKGROUND
There has been an increasing incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) infections in recent years. The objective of this study was to determine specific risk factors for and outcome of bacteremia due to CRAB isolates among our ICU patients with A. baumannii bacteremia.


METHODS
Among 96 patients with ICU-acquired A. baumannii bacteremia, 30 patients with CRAB were compared with the remaining 66 with carbapenem-susceptible A. baumannii (CSAB) isolates.


RESULTS
Recent ventilator-associated pneumonia (VAP) due to CRAB (OR 16.74, 95% CI 3.16-88.79, p = 0.001) and a greater number of intravascular devices (OR 3.93, 95% CI 1.9-13.0, p = 0.025) were independently associated with CRAB bacteremia acquisition. Patients with CRAB bacteremia had a lower severity of illness on admission than those with CSAB. Although, by univariate analysis, patients with CRAB were more likely to have had exposure to colistin, carbapenems and linezolid, multivariate analysis did not revealed any significant association. The mortality was not different between patients with CRAB and CSAB bacteremia (43.3 vs. 46.9%, p = 0.740). Severity of organ failure (OR 1.42, 95% CI 1.20-1.67, p = 0.001), and increased white blood cell (WBC) count (OR 1.09, 95% CI 1.01-1.19, p = 0.036), at bacteremia onset were independently associated with mortality.


CONCLUSIONS
VAP due to CRAB and excess use of intravascular devices are the most important risk factors for CRAB bacteremia in our ICU. Severity of organ failure and WBC count at A. baumannii bacteremia onset are independently associated with mortality.
Routsi
C
C
1st Department of Intensive Care, Evangelismos Hospital, University of Athens Medical School, 45-47 Ipsilantou Str., 106 76, Athens, Greece. croutsi@hotmail.com
Pratikaki
M
M
Platsouka
E
E
Sotiropoulou
C
C
Nanas
S
S
Markaki
V
V
Vrettou
C
C
Paniara
O
O
Giamarellou
H
H
Roussos
C
C
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D015780:Carbapenems