Abstract
Acinetobacter baumannii has been a dreadful problem for ICU physicians for a long time. Bacteremic pneumonia (BP) caused by this organism has a higher mortality compared to other organisms. Between 2012 and 2015, 86 BP and 89 non-bacteremic pneumonia (NBP) patients from five ICUs were enrolled into the study. The 7-day and 14-day mortality rates were higher in BP patients than in NBP patients (P < 0.001). Procalcitonin elevation, high APACHEII score and recent surgery, were independently associated with BP episodes. Acute respiratory distress syndrome, coma, high APACHEII score and procalcitonin elevation, were independently associated with mortality in the BP group. Extensively drug-resistant isolates were detected in 34.9% of BP and 25.8% of NBP isolates. PFGE identified 12 and 9 genotypes in the BP and NBP isolates, respectively, with 6 genotypes shared by both groups. ST195 was the most prevalent type (40%), followed by ST457 (18.9%). The pandemic clonal complex 92 was predominant, accounting for 94.3% of the strains. For all studied periods, mortality remained higher in the BP than the NBP group. Disease severity was the main risk factor for high mortality in the BP group, and other factors related to mortality were infection, and not treatment or microbiology-related.
Highlights
The prevalence of health care associated infections caused by Acinetobacter spp. is increasing among immunocompromised hosts and patients in intensive care units (ICUs)[1,2]
In order to establish the causal relationship of bacteria causing pneumonia, such as P. aeruginosa and A. baumannii, which have high incidence of colonization in lower respiratory tract (LRT), some authors suggest defining pneumonia caused by a “definite pathogen” as bacteremic pneumonia (BP), and the one caused by a “probable pathogen” or a “possible pathogen” as non-bacteremic pneumonia (NBP)[6,7]
Male patients accounted for 81.4% (70/86) in the BP group and 83.1% (74/89) in the NBP group
Summary
The prevalence of health care associated infections caused by Acinetobacter spp. is increasing among immunocompromised hosts and patients in intensive care units (ICUs)[1,2]. Infections caused by this organism present a serious clinical challenge for physicians in health-care settings, resulting in much higher crude mortality rate than other bacterial strains from HAP/VAP3. Numerous studies have investigated the risk factors and mortality of A. baumannii bacteremia, with findings consistently suggesting that A. baumannii bacteremia has a higher mortality rate than other organisms, ranging from 30% to 60%, especially for imipenem-resistant A. baumannii[6,8]. It remains unclear what the attributed mortality of A. baumannii bloodstream infections is by different sites of infection. The objective of this study was to identify independent risk factors associated with mortality due to A. baumannii BP and NBP by comparative analysis of clinical characteristics, final outcomes of bacteremic patients, and microbiological features
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