370

Abstract

Introduction: Acinetobacter baumanni is a serious nosocomial pathogen worldwide. Cancer patients have been found to be at high risk of developing Acinetobacter-related infections. Hypothesis: We describe the characteristics and outcomes of severe sepsis and septic shock due to Acinetobacter baumannii in cancer patients. We hypothesize that the outcomes of such a serious infection in immunocompromised patients is poor. Methods: The ICU electronic database was used to identify all cancer patients who developed severe sepsis and septic shock due to Acinetobacter baumannii between Jan 1, 2007 and Dec 31, 2010. The demographics of all patients were recorded. In addition, organ failure, the site of positive cultures, type of infection, incidence of drug resistance, length of ICU stay and ICU mortality were determined. Results: Over the study period, 30 patients were identified; mean age was 52 years (range 22-72), mean APACHE II was 23.9 (range 11-42), 17 (56.7%) patients were male and 17 (56.7%) had hematological malignancies. Upon presentation, 10(33.4%) patients had 1 organ failure, 12(40%) had 2 organ failure, 3(9.9%) had 3 organ failure, and 2(6.7%) had 4 organ failure. Twenty-four (80%) patients had one positive culture upon presentation, while 4 (13.3%) had two positive cultures and 1 (3.3%) had three positive cultures. The majority of the positive cultures were in the blood (n=12; 32%), transbronchial aspirate/sputum (n=12; 32%%) and wound (n=5; 24.3%). All reported Acinetobacter baumannii were carbapenem-resistant. Most common types of infection were nosocomial pneumonia (n=24; 80%), permanent central line infections (n=7; 23.3%) and temporary central line infections (n=6; 20%). The ICU length of stay was 10 days (range 0-28) and ICU mortality was reported in 21 patients (70%). Conclusions: Severe sepsis and septic shock due to carbapenem-resistant acinetobacter baumanni in cancer patients is associated with high mortality. Measures are needed to reduce the incidence of central line infections in this patient population.