title: Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia.
abstract: OBJECTIVE
  Identification of risks of mortality for carbapenem-resistant Acinetobacter baumannii (CRAB), with early implementation of an appropriate therapy, is crucial for the patients' outcome. The aim of this study was to survey mortality risk factors in 182 patients with CRAB bacteremia in a medical center in Taiwan.
  
  
  METHODS
  A total of 182 isolates of CRAB bacteremia were collected from 2009 to 2012 in Mackay Memorial Hospital, Taipei, Taiwan These isolates were identified by using the genotypic method. Risk of attributable mortality analysis was carried out with a Cox proportional hazards model.
  
  
  RESULTS
  The 182 CRAB isolates belonged to 38 different pulsotypes. The attributable mortality rate of the 182 patients was 58.24%. The risk factors for attributable mortality included intensive care unit stay [hazard ratio (HR): 2.27; p = 0.011], an Acute Physiology and Chronic Health Evaluation II score of >20 (HR: 2.19; p < 0.001), respiratory tract as the origin of bacteremia (HR: 3.40; p < 0.001), and previous use of ceftriaxone (HR: 2.51; p = 0.011). The appropriateness of antimicrobial therapy was 18.87% (20/106) in the mortality group versus 88.16% (67/76) in the survivor group (p < 0.001). The sensitivity of CRAB to colistin was 100% and to tigecycline was 40.11%.
  
  
  CONCLUSIONS
  The risk factors for mortality for CRAB included intensive care unit stay, a high Acute Physiology and Chronic Health Evaluation II score, respiratory tract as the origin of bacteremia, and previous use of ceftriaxone. Early implementation of an antimicrobial agent that had the highest in vitro activity against CRAB in patients at risk of CRAB bacteremia and high mortality may improve their outcome.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan; Graduate Institute of Bioengineering, Tatung University, Taipei, Taiwan; Mackay College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chang-Pan
authors.initials: CP
authors.lastname: Liu
authors.affiliation: Department of Medicine, Mackay Medical College, Taipei, Taiwan; Mackay College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, Mackay Memorial Hospital, Taipei, Taiwan; Division of Gastroenterology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Shou-Chuan
authors.initials: SC
authors.lastname: Shih
authors.affiliation: Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Nai-Yu
authors.initials: NY
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan.
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Wu
authors.affiliation: Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Mackay College of Medicine, Nursing and Management, Taipei, Taiwan.
authors.forename: Fang-Ju
authors.initials: FJ
authors.lastname: Sun
authors.affiliation: Graduate Institute of Bioengineering, Tatung University, Taipei, Taiwan.
authors.forename: Shan-Fan
authors.initials: SF
authors.lastname: Chow
authors.affiliation: School of Medicine, National Yang Ming University, Taipei, Taiwan; Cheng-Hsin General Hospital, Taipei, Taiwan. Electronic address: tecklayyy@gmail.com.
authors.forename: Te-Li
authors.initials: TL
authors.lastname: Chen
authors.affiliation: Graduate Institute of Bioengineering, Tatung University, Taipei, Taiwan. Electronic address: tryan@hotmail.com.tw.
authors.forename: Tsong-Rong
authors.initials: TR
authors.lastname: Yan
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D015780:Carbapenems / Q000494:pharmacology*; D003091:Colistin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D000078304:Tigecycline
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000078304:Tigecycline; D008911:Minocycline; D003091:Colistin
keywords: Acinetobacter baumannii, bacteremia; mortality; risk factors