title: High mortality associated with Acinetobacter species infection in liver transplant patients.
abstract: BACKGROUND
  Acinetobacter species have become increasingly important nosocomial pathogens worldwide and can result in a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis, among others. The aim of this study was to investigate clinical characteristics, mortality, and outcomes among liver transplant recipients with Acinetobacter species infections.
  
  
  METHODS
  We retrospectively analyzed 451 subjects who had undergone living donor liver transplantations between January 2001 and May 2010. Pandrug-resistant (PDR) Acinetobacter species were defined as resistant to all commercially available antibiotics except colistin.
  
  
  RESULTS
  Infectious complications due to Acinetobacter species appeared in 26 patients (5.8%) with a total of 37 episodes. Of the species identified, 34 were Acinetobacter baumannii and 3 Acinetobacter Iwoffiii. The presumed sources of infection were the biliary tract (n = 21, 56.8%), lung (n = 7, 18.9%), intra-abdomen (n = 6, 16.2%), catheter (n = 2, 5.4%), and urinary tract (n = 1, 3.6%). Among the 37 Acinetobacter species, 75.7% (28/37) were PDR species. Age, duration of intensive care unit stay, Child-Pugh score, and Model for End-stage Liver Disease score were not significant risk factors for Acinetobacter species infection. However, the overall mortality among patients with Acinetobacter species infections was 50% (13/26), which was significantly higher than that among those free of infection (50% vs 11.5%, P < .05). Multivariate analysis using a Cox regression model showed that inappropriate antimicrobial treatment was a significant independent risk factor for mortality among patients with Acinetobacter species infections (hazard Ratio = 4.19, 95% confidence interval 1.1-18.7; P = .06).
  
  
  CONCLUSIONS
  Patients with Acinetobacter species infections after liver transplantation show a significantly worse prognosis. PDR Acinetobacter species have been a major problem in our center.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Yoon
authors.forename: S I
authors.initials: SI
authors.lastname: Kim
authors.forename: K W
authors.initials: KW
authors.lastname: Hong
authors.forename: J I
authors.initials: JI
authors.lastname: Kim
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.forename: S K
authors.initials: SK
authors.lastname: Yoon
authors.forename: Y K
authors.initials: YK
authors.lastname: You
authors.forename: M D
authors.initials: MD
authors.lastname: Lee
authors.forename: I S
authors.initials: IS
authors.lastname: Moon
authors.forename: D G
authors.initials: DG
authors.lastname: Kim
authors.forename: M W
authors.initials: MW
authors.lastname: Kang
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents