Changes in the early mortality of adult patients with carbapenem-resistant Acinetobacter baumannii bacteremia during 11 years at an academic medical center.

Abstract

In the past decade, carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a major pathogen of serious infections in critically ill adult patients. Despite very limited antimicrobial options, clinicians have sought to reduce the mortality of patients with serious CRAB infections. To determine whether these long-term efforts effectively lessened the mortality of such patients, we investigated changes in the early mortality of adult patients with CRAB bacteremia and related clinical factors. We reviewed clinical data from 111 adult patients with monomicrobial CRAB bacteremia admitted to an academic medical center between 2006 and 2016. The 14-day mortality rate from 2013 to 2016 was lower than that from 2009 to 2012 (43.4% vs. 71.1%, p=0.01). When the clinical characteristics of adult patients with CRAB bacteremia from 2013 to 2016 were compared to those of the patients from 2009 to 2012, chronic lung disease (6.7% vs. 24.4%, p=0.01), a recent history of mechanical ventilation (38.3% vs. 57.8%, p=0.048), and pneumonia (48.3% vs. 68.9%, p=0.04) were less frequent in 2013-2016, while neurological disease (43.3% vs. 22.2%, p=0.02), central venous catheter infection (20.0% vs. 6.7%, p=0.05), and early appropriate antimicrobial therapy (46.7% vs. 24.4%, p=0.01) were more frequent. The 14-day mortality rate of adult patients with CRAB bacteremia was reduced during 2013-2016. This decrease was associated with early appropriate antimicrobial therapy and a lower proportion of patients with bacteremic pneumonia, which seemed to result from improved hospital infection control during that time period.