Outcomes of critically ill cancer patients with Acinetobacter baumannii infection.
OBJECTIVE
To describe the intensive care unit (ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii (AB) infection.


METHODS
This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico (INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.


RESULTS
Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23 (4.6%) of whom developed AB infections. Sixteen (60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock (56.2%) and postoperative care (21.7%). The respiratory tract was the most frequent site of AB infection (91.3%). The most common organ dysfunction observed in our group of patients were the respiratory (100%), cardiovascular (100%), hepatic (73.9%) and renal dysfunction (65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7% (2/17) compared with 66.6% (4/6) for the group of patients with 4 or more organ system dysfunctions (P = 0.021). Multivariate analysis identified blood lactate levels (BLL) as the only variable independently associated with in-ICU death (OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.


CONCLUSIONS
The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Silvio A
SA
Ñamendys-Silva
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Paulina
P
Correa-García
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Francisco J
FJ
García-Guillén
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
María O
MO
González-Herrera
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Américo
A
Pérez-Alonso
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Julia
J
Texcocano-Becerra
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Angel
A
Herrera-Gómez
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Patricia
P
Cornejo-Juárez
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Abelardo
A
Meneses-García
Acinetobacter baumannii; Cancer patients; Critical care; Intensive care; Outcomes