title: [Analysis of clinical manifestations and risk factors of mortality in Acinetobacter baumannii bloodstream infection].
abstract: OBJECTIVE
  To explore the clinical manifestations, antimicrobial therapy, and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.
  
  
  METHODS
  Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis, the patients were divided into death group (n=76) and survival group (n=77). Data related to demographic and clinical characteristics, underlying diseases, treatment, invasive procedures, bacterial resistance to antibiotics, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ )scores at onset, and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.
  
  
  RESULTS
  This study included 153 patients with Acinetobacter baumannii bloodstream infection. The 28-day mortality was 49.7%. The independent risk factors of mortality were APACHE Ⅱ score ≥ 22 at onset (OR=15.7, 95%CI 5.1-48.1, P<0.001), septic shock(OR=6.3, 95%CI 1.9-21.3, P=0.003), and administration of steroids(OR=3.6, 95%CI 1.0-12.3, P=0.043). Compared with subjects treated with non-cefoperazone-sulbactam-based regimen , those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii(MDR-AB) had significantly lower mortality on day7, day14 and day28(8.9% vs 59.2%, 31.1% vs 65.8%, 44.4% vs 72.4% respectively).
  
  
  CONCLUSIONS
  The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month. Administration of steroids and septic shock are associated with poor prognosis. APACHEⅡ score ≥ 22 at onset predicts adverse outcome. Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.
authors.affiliation: Department of Respiratory Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
authors.forename: Yinwei
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Zhou
authors.forename: Hongliu
authors.initials: H
authors.lastname: Cai
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.forename: Qian
authors.initials: Q
authors.lastname: Shen
authors.forename: Yihong
authors.initials: Y
authors.lastname: Shen
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhou
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D040981:Acinetobacter baumannii; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D002438:Cefoperazone / Q000627:therapeutic use; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000175:diagnosis / Q000473:pathology; D013407:Sulbactam / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002438:Cefoperazone; D013407:Sulbactam