title: Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: impact of appropriate antimicrobial therapy.
abstract: This study investigated predictors associated with 14-day mortality, and focused especially on the impact of appropriate antimicrobial treatment among patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia. This retrospective study was performed at a tertiary care hospital in Korea from June 2007 to June 2010. Antibiotic therapy was considered appropriate if the antibiotics were administered via an appropriate route within 24 hr after the result of blood culture, had in vitro sensitivity to isolated strains, and of an adequate dosage according to the current guidelines. Ninety-five patients with A. baumannii bacteremia were included; of these, 53 (55.8%) were infected with CRAB. The overall infection-related 14-day mortality was higher in patients receiving inappropriate antimicrobial therapy than in patients receiving appropriate therapy (59.5% [22/37] vs 13.8% [8/58], P < 0.05). Multivariate analysis showed that septic shock (OR 10.5, 95% CI, 1.93-57.4; P = 0.006), carbapenem-resistance (OR 7.29, 95% CI 1.57-33.8; P = 0.01), pneumonia as a source of bacteremia (OR 5.29, 95% CI 1.07-26.1; P = 0.04), and inappropriate antimicrobial therapy (OR 8.05, 95% CI 1.65-39.2; P = 0.009) were independent risk factors for 14-day mortality. Early definite antimicrobial therapy had an influence on favorable outcomes in patients with A. baumannii bacteremia.
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Youn Jeong
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Kyung-Wook
authors.initials: KW
authors.lastname: Hong
authors.forename: Yang Ree
authors.initials: YR
authors.lastname: Kim
authors.forename: Yeon Joon
authors.initials: YJ
authors.lastname: Park
authors.forename: Moon-Won
authors.initials: MW
authors.lastname: Kang
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000494:pharmacology; D048909:Diabetes Complications; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems