title: Incidence and risk factors for carbapenem- and multidrug-resistant Acinetobacter baumannii bacteremia in hematopoietic stem cell transplantation recipients.
abstract: BACKGROUND
  Bacteremia with multidrug-resistant (MDR) Acinetobacter baumannii with carbapenem resistance is an important healthcare-associated infection that increases morbidity and mortality in immunocompromised patients. The aim of this study was to assess the annual incidence and clinical characteristics of such bacteremia and to identify the risk factors for infection in hematopoietic stem cell transplantation (HSCT) recipients.
  
  
  METHODS
  A retrospective cohort and case-control study was conducted in 483 HSCT recipients between January 2005 and December 2011 at a single tertiary center. Thirty-eight control HSCT patients without evidence of post-transplant infection were matched with 19 patients with bacteremia due to MDR A. baumannii in a 2:1 ratio.
  
  
  RESULTS
  The total incidence of carbapenem-resistant-MDR A. baumannii bacteremia was 0.52 cases/10,000 patient-days. In most cases (17 of 19, 89.5%), bacteremia developed after engraftment. Pneumonia was the origin of bacteremia in all patients. Eighteen (94.7%) patients with bacteremia and 3 (8.3%) without bacteremia died. In multivariate regression analyses, the duration between admission and HSCT (odds ratio (OR) 2.19 per 1-day increase, p = 0.030) and a history of care in an intensive care unit after HSCT (OR 32.2, p = 0.021) were independent risk factors for the development of carbapenem-resistant-MDR A. baumannii bacteremia.
  
  
  CONCLUSIONS
  We report that carbapenem-resistant-MDR A. baumannii bacteremia in HSCT recipients is a fatal infectious complication and mainly develops after engraftment.
authors: From the Department of Internal Medicine, Yonsei University College of Medicine , Seoul , Republic of Korea.
authors: Sun Bean
authors: SB
authors: Kim
authors: Yoo Hong
authors: YH
authors: Min
authors: June-Won
authors: JW
authors: Cheong
authors: Jin Seok
authors: JS
authors: Kim
authors: Soo Jeong
authors: SJ
authors: Kim
authors: Nam Su
authors: NS
authors: Ku
authors: Su Jin
authors: SJ
authors: Jeong
authors: Sang Hoon
authors: SH
authors: Han
authors: Jun Yong
authors: JY
authors: Choi
authors: Young Goo
authors: YG
authors: Song
authors: June Myung
authors: JM
authors: Kim
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers