title: Risk factors for imipenem-nonsusceptible Acinetobacter nosocomialis bloodstream infection.
abstract: BACKGROUND
  The emergence of imipenem-nonsusceptible (INS) Acinetobacter baumannii complex has had a great impact on healthcare systems worldwide. Understanding the risk factors related to INS infection is useful for infection control. The risk factors for INS A. baumannii have been well documented; however, the risk factors related to INS Acinetobacter nosocomialis infection lack documentation. The purpose of this study was to identify the risk factors associated with INS A. nosocomialis bacteremia.
  
  
  METHODS
  This retrospective 9-year study included 329 adults with A. nosocomialis bacteremia in a tertiary medical center in Taiwan. Acinetobacter nosocomialis was identified using a multiplex polymerase chain reaction method and sequence analysis of a 16S-23S intergenic spacer.
  
  
  RESULTS
  Among 329 patients with A. nosocomialis bacteremia, 67 had INS isolates (20.4%). Patients with INS isolates tended to have a more severe form of the diseases [with ICU admission and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score], specific underlying diseases (associated with chronic lung diseases and end-stage renal diseases, but less commonly alcoholism and chemotherapy), multiple invasive procedures, pneumonia as a primary focus of infection, and prior antimicrobial use (sulbactam, antipseudomonal penicillins, aminoglycosides, and carbapenems). Multivariable analysis showed that ICU admission, chronic lung diseases, arterial line catheterization, total parenteral nutrition, and prior use of carbapenems were independent risk factors; prior use of carbapenems was found to be the most influential (odds ratio 6.36, 95% confidence interval 2.00-20.21; p = 0.002).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study describing the risk factors associated with INS A. nosocomialis bacteremia. Regulated antibiotic control policy, especially for carbapenem, and infection control measures targeting patients hospitalized in ICU, with chronic lung diseases and multiple invasive procedures, may be helpful in reducing INS A. nosocomialis infection.
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, Lo-Tung Pohai Hospital, Yi-Lan, Taiwan.
authors: Lei
authors: L
authors: Huang
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Te-Li
authors: TL
authors: Chen
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Chutung Veterans Hospital, Chutung, Taiwan.
authors: Yi-Tzu
authors: YT
authors: Lee
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Mei-Hui
authors: MH
authors: Lee
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan. Electronic address: ludwigvantw@gmail.com.
authors: Shu-Chen
authors: SC
authors: Kuo
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Kwok-Woon
authors: KW
authors: Yu
authors: National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
authors: Horng-Yunn
authors: HY
authors: Dou
authors: Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Chang-Phone
authors: CP
authors: Fung
mesh_terms: D000046:Academic Medical Centers; D000150:Acinetobacter / Q000187:drug effects* / Q000235:genetics; D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology*; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia; D003428:Cross Infection; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D018440:beta-Lactam Resistance
chemical_list: D015378:Imipenem
keywords: Acinetobacter nosocomialis; Bacteremia; Imipenem resistance; Risk factors