title: Risk Factors and Clinical Outcomes for Patients With Acinetobacter baumannii Bacteremia.
abstract: Acinetobacter (A.) baumannii, an opportunistic nosocomial pathogen that can cause significant morbidity and mortality, has emerged as a worldwide problem. This study aimed to analyze the clinical features and outcomes of patients with A. baumannii bacteremia and determine the factors influencing survival by using 14-day mortality as the primary endpoint. A 6-year retrospective study of 122 cases with monomicrobial A. baumannii bacteremia was conducted in Chinese People's Liberation Army (PLA) General Hospital from January 2008 to April 2014. Predictors of 14-day mortality were identified by logistic regression analysis. The overall 14-day mortality rate was 40.2% (49 of 122 patients). Multivariable analysis revealed that independent predictors of 14-day mortality included severity of illness defined by Pitt Bacteremia Score (PBS) (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.340-0.619; P < 0.001), neutropenia (OR, 18.02; 95% CI, 1.667-194.67; P = 0.017), and malignancy (OR, 4.63; 95% CI, 1.292-16.588; P = 0.019). The effect of malignancy was influenced by neutropenia (OR for interaction term, 1.60; 95% CI, 1.15-2.22; P = 0.005). A subgroup analysis revealed that 14-day mortality rate for patients with underlying hematological malignancies and solid tumors was 75% (12/16) and 40% (12/30), respectively. Survival analysis revealed that mortality in patients with hematological malignancies was higher than that in patients with solid tumors (P = 0.032). The outcomes of patients with A. baumannii bacteremia were related to PBS, neutropenia, and malignancy. Compared with solid tumors, patients with hematological malignancies had a higher mortality in the setting of A. baumannii bacteremia.
authors.affiliation: From the Department of Hematology, Chinese People's Liberation Army General Hospital, Haidian District (ZG, SZ, XZ, CG, WH), Department of Neurology, Chinese People's Liberation Army 305 Hospital, Xicheng District, Beijing (YH), Sanya Sanitorium of Chinese People's Armed Police Forces (TM), and Department of Hematology, Hainan Branch of Chinese People's Liberation Army General Hospital (TM, WH), Sanya City, Hainan, China.
authors.forename: Zhenyang
authors.initials: Z
authors.lastname: Gu
authors.forename: Yuliang
authors.initials: Y
authors.lastname: Han
authors.forename: Taojiang
authors.initials: T
authors.lastname: Meng
authors.forename: Shasha
authors.initials: S
authors.lastname: Zhao
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Zhao
authors.forename: Chunji
authors.initials: C
authors.lastname: Gao
authors.forename: Wenrong
authors.initials: W
authors.lastname: Huang
mesh_terms: D000151:Acinetobacter Infections / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index