title: ICU-associated Acinetobacter baumannii colonisation/infection in a high HIV-prevalence resource-poor setting.
abstract: BACKGROUND
  There are hardly any data about the incidence, risk factors and outcomes of ICU-associated A.baumannii colonisation/infection in HIV-infected and uninfected persons from resource-poor settings like Africa.
  
  
  METHODS
  We reviewed the case records of patients with A.baumannii colonisation/infection admitted into the adult respiratory and surgical ICUs in Cape Town, South Africa, from January 1 to December 31 2008. In contrast to colonisation, infection was defined as isolation of A.baumannii from any biological site in conjunction with a compatible clinical picture warranting treatment with antibiotics effective against A.baumannii.
  
  
  RESULTS
  The incidence of A.baumannii colonisation/infection in 268 patients was 15 per 100 person-years, with an in-ICU mortality of 26.5 per 100 person-years. The average length of stay in ICU was 15 days (range 1-150). A.baumannii was most commonly isolated from the respiratory tract followed by the bloodstream. Independent predictors of mortality included older age (p = 0.02), low CD4 count if HIV-infected (p = 0.038), surgical intervention (p = 0.047), co-morbid Gram-negative sepsis (p = 0.01), high APACHE-II score (p = 0.001), multi-organ dysfunction syndrome (p = 0.012), and a positive blood culture for A.baumannii (p = 0.017). Of 21 A.baumannii colonised/infected HIV-positive persons those with clinical AIDS (CD4<200 cells/mm(3)) had significantly higher in-ICU mortality and were more likely to have a positive blood culture. Conclusion In this resource-poor setting A.baumannii infection in critically ill patients is common and associated with high mortality. HIV co-infected patients with advanced immunosuppression are at higher risk of death.
authors.affiliation: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Ntobeko B A
authors.initials: NB
authors.lastname: Ntusi
authors.forename: Motasim
authors.initials: M
authors.lastname: Badri
authors.forename: Hoosain
authors.initials: H
authors.lastname: Khalfey
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Stephen
authors.initials: S
authors.lastname: Oliver
authors.forename: Jenna
authors.initials: J
authors.lastname: Piercy
authors.forename: Richard
authors.initials: R
authors.lastname: Raine
authors.forename: Ivan
authors.initials: I
authors.lastname: Joubert
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
mesh_terms: D000151:Acinetobacter Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents