title: Risk of Mortality of Catheter-Related Bloodstream Infections Caused by Acinetobacter Species: Is Early Removal of the Catheters Associated With a Better Survival Outcome?
abstract: OBJECTIVE
  Bloodstream infections (BSIs) caused by Acinetobacter species have been extensively reported, however, which majorly focused on respiratory tract infections. The risk of mortality and the effect of early catheter removal on survival in catheter-related BSIs (CRBSIs) caused by Acinetobacter spp. remain unclear. This study aims to investigate that.
  
  
  METHODS
  This is a retrospective multicentric study conducted in Taiwan from 2012 to 2014. Patients with at least 1 positive blood culture and catheter culture for the same Acinetobacter spp., showing symptoms and signs of CRBSIs, were included (n = 119). Risk factors for 30-day mortality were analyzed using a logistic regression model. The characteristics of patients with early catheter removal (within 48 hours after CRBSIs) were compared to those without removal matching for age, sex, and disease severity.
  
  
  RESULTS
  There were no differences in 30-day mortality with regard to causative Acinetobacter spp., catheter type, site, and appropriateness of antimicrobial therapy. Patients with higher Acute Physiologic and Chronic Health Evaluation (APACHE) II scores (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.02-1.23; P = .014), shock (OR: 6.43; 95% CI: 1.28-32.33; P = .024), and longer hospitalization before CRBSIs (OR: 1.04; 95% CI: 1.00-1.08; P = .027) had a significantly higher 30-day mortality rate. Early removal of catheters after CRBSIs was not associated with better survival benefits.
  
  
  CONCLUSIONS
  Higher disease severity (APACHE II score), shock, and longer hospitalization before bacteremia were independently associated with a higher 30-day mortality in CRBSIs caused by Acinetobacter spp. In previous published guidelines, infected catheters were suggested to be removed in CRBSIs caused by gram-negative bacilli. Even though early removal of catheters did not associate with a better survival outcome in current results, it should be judiciously evaluated according to the clinical conditions and risks individually. For better elucidation of these issues, further well-controlled prospective study may be warranted.
authors.affiliation: 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.|2 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lee
authors.affiliation: 3 Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|4 School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Tzu
authors.initials: YT
authors.lastname: Lee
authors.affiliation: 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yung-Chih
authors.initials: YC
authors.lastname: Wang
authors.affiliation: 3 Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chung-Ting
authors.initials: CT
authors.lastname: Chen
authors.affiliation: 5 Clinical Microbiology Laboratory, Division of Clinical Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jun-Ren
authors.initials: JR
authors.lastname: Sun
authors.affiliation: 6 Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.|7 Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chang-Pan
authors.initials: CP
authors.lastname: Liu
authors.affiliation: 8 Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yuan-Meng
authors.initials: YM
authors.lastname: Liu
authors.affiliation: 9 National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Chiu
authors.affiliation: 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ya-Sung
authors.initials: YS
authors.lastname: Yang
authors.affiliation: 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.|2 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jung-Chung
authors.initials: JC
authors.lastname: Lin
authors.affiliation: 2 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.|10 Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Te-Li
authors.initials: TL
authors.lastname: Chen
mesh_terms: D018806:APACHE; D000150:Acinetobacter / Q000302:isolation & purification*; D000151:Acinetobacter Infections / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D003422:Critical Care; D020878:Device Removal / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D017408:Guidelines as Topic; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan
chemical_list: D000890:Anti-Infective Agents
keywords: Acinetobacter; bacteremia; bloodstream infection; catheter; mortality; risk