Predictors of mortality of Acinetobacter baumannii infections: A 2-year prospective study in a Greek surgical intensive care unit.
BACKGROUND
Nosocomial infections are a frequent and continuously increasing problem worldwide, have a rapidly increasing multidrug resistance to antibiotics, and are associated with significant morbidity and mortality.


OBJECTIVE
Our objectives were to evaluate Acinetobacter baumannii infection incidence in our surgical intensive care unit (SICU), the clinical features and outcome of these patients, and, particularly, to investigate predictors of A baumannii infection-related mortality.


METHODS
Ours was a prospective study of all patients with ICU-acquired A baumannii infection from January 1, 2006, to December 31, 2007.


RESULTS
Among 680 patients, 60 (8.8%) sustained A baumannii infection. Mean age was 68.4 ± 6.2 years, Acute Physiology and Chronic Health Evaluation (APACHE) II score on SICU admission 20.6 ± 8.1 and Sequential Organ Failure Assessment (SOFA) score on infection day 9.5 ± 4.2 (women: 50%). Multidrug resistance, morbidity, and mortality were 45%, 65%, and 46.6% (n = 28), respectively. In multivariate analysis, age (P = .03; odds ratio [OR], 1.13; 95% confidence interval [CI]: 1.018-1.259), acute renal failure (P = .001; OR, 17.9; 95% CI: 6.628-75.565), and thrombocytopenia (P = .03; OR, 26.4; 95% CI: 1.234-56.926) complicating the infection and subsequent Enterococcus faecium bacteremia (P = .01; OR, 3.5; 95% CI: 1.84-6.95) were mortality predictors.


CONCLUSIONS
A baumannii infections are frequent and associated with high drug multiresistance, morbidity, and mortality. Age, renal failure, thrombocytopenia, and subsequent E faecium bacteremia were predictors of A baumannii infection-associated mortality.
Katsaragakis
Stilianos
S
Surgical Intensive Care Unit, First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.
Markogiannakis
Haridimos
H
Samara
Eleni
E
Pachylaki
Nikoleta
N
Theodoraki
Eleni-Maria
EM
Xanthaki
Anna
A
Toutouza
Marina
M
Toutouzas
Konstantinos G
KG
Theodorou
Dimitrios
D
D000151:Acinetobacter Infections / Q000453:epidemiology / Q000401:mortality*; D040981:Acinetobacter baumannii; D000368:Aged; D000375:Aging; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D016984:Enterococcus faecium; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents