title: Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit.
abstract: To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Song Yee
authors.initials: SY
authors.lastname: Kim
authors.forename: Ji Ye
authors.initials: JY
authors.lastname: Jung
authors.forename: Young Ae
authors.initials: YA
authors.lastname: Kang
authors.forename: Joo Eun
authors.initials: JE
authors.lastname: Lim
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Sang Kook
authors.initials: SK
authors.lastname: Lee
authors.forename: Seon Cheol
authors.initials: SC
authors.lastname: Park
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Chung
authors.forename: Byung Hoon
authors.initials: BH
authors.lastname: Park
authors.forename: Young Sam
authors.initials: YS
authors.lastname: Kim
authors.forename: Se Kyu
authors.initials: SK
authors.lastname: Kim
authors.forename: Joon
authors.initials: J
authors.lastname: Chang
authors.forename: Moo Suk
authors.initials: MS
authors.lastname: Park
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems