title: Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia.
abstract: This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: maristelapf@uol.com.br.
authors.forename: M P
authors.initials: MP
authors.lastname: Freire
authors.affiliation: Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil.
authors.forename: D
authors.initials: D
authors.lastname: de Oliveira Garcia
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: C P
authors.initials: CP
authors.lastname: Garcia
authors.affiliation: Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil.
authors.forename: M F
authors.initials: MF
authors.lastname: Campagnari Bueno
authors.affiliation: Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil.
authors.forename: C H
authors.initials: CH
authors.lastname: Camargo
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: A S G
authors.initials: ASG
authors.lastname: Kono Magri
authors.affiliation: Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil.
authors.forename: G R
authors.initials: GR
authors.lastname: Francisco
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Reghini
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: M F
authors.initials: MF
authors.lastname: Vieira
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: K Y
authors.initials: KY
authors.lastname: Ibrahim
authors.affiliation: Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Intensive Care Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Hajjar
authors.affiliation: Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: A S
authors.initials: AS
authors.lastname: Levin
authors.affiliation: Department of Oncology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: P M
authors.initials: PM
authors.lastname: Hoff
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: L C
authors.initials: LC
authors.lastname: Pierrotti
authors.affiliation: Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Abdala
mesh_terms: D000151:Acinetobacter Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acinetobacter baumannii; bacterial infection; bloodstream infection; cancer; carbapenem resistance; intensive care; mortality; multidrug resistance; neutropenia; tumour infection