Risk factors for carbapenem non-susceptibility and mortality in Acinetobacter baumannii bacteremia in children.
OBJECTIVE
To examine the risk factors of carbapenem non-susceptibility and mortality among children with Acinetobacter baumannii bacteremia.


METHODS
A retrospective chart review was conducted of 180 cases with A. baumannii bacteremia.


RESULTS
The 30-day mortality risk of A. baumannii bacteremia was 26.1%. Carbapenem-non-susceptible A. baumannii was identified in 51.7% of cases. Logistic regression analysis indicated that prematurity, use of mechanical ventilation, and prior exposure to carbapenem antibiotics were independently associated with carbapenem-non-susceptible A. baumannii bacteremia, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of 3.36 (1.17-9.65), 5.59 (2.24-13.97), and 2.97 (1.01-8.77), respectively. Further, carbapenem non-susceptibility, cancer-related neutropenia, organ dysfunction, admission to the intensive care unit, catheter-related bacteremia, and treatment with sulbactam-containing regimens were associated with mortality with aORs and 95% CIs of 4.76 (1.58-14.32), 4.54 (1.09-18.79), 25.95 (5.13-131.33), 3.53 (1.29-9.71), 0.25 (0.084-0.72), and 0.14 (0.046-0.45), respectively.


CONCLUSIONS
The majority of A. baumannii bacteremia was caused by carbapenem-non-susceptible strains with a high mortality rate. Carbapenem non-susceptibility, cancer-related neutropenia, the presence of organ dysfunction, and admission to an intensive care unit were associated with an increased mortality risk, whereas catheter-related bacteremia and treatment with a sulbactam-containing regimen were associated with decreased mortality among children with A. baumannii bacteremia.
Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Rajathevi, Bangkok, Thailand. waruneep@gmail.com
Warunee
W
Punpanich
Natthacha
N
Nithitamsakun
Vipa
V
Treeratweeraphong
Piyarat
P
Suntarattiwong
D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000293:Adolescent; D016470:Bacteremia / Q000188:drug therapy*; D015780:Carbapenems / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D015996:Survival Rate; D013785:Thailand
D015780:Carbapenems