Abstract
Purpose This study was aimed to identify the determinants of in-hospital mortality in Acinetobacter baumannii (A. baumannii) bacteremia and to assess impact of carbapenem resistance on mortality. Methods A five-year case-control study was conducted from January 2011 to December 2015 in a tertiary teaching hospital with 3200 beds, Southwest China. Clinical outcomes and potential determinants of mortality in patients with nosocomial A. baumannii bacteremia and carbapenem-resistant A. baumannii (CRAB) bacteremia were evaluated using Cox and logistic regression analyses. Results A total of 118 patients with nosocomial A. baumannii bacteremia were included. Seventy-one percent (84/118) of them had carbapenem-resistant A. baumannii (CRAB) bacteremia. The in-hospital mortality of nosocomial A. baumannii bacteremia was 21.2%, and the attributable in-hospital mortality rate due to CRAB was 21.5%. Significant difference of 30-day in-hospital mortality in the Kaplan–Meier curves was found between CRAB and CSAB groups (log-rank test, P=0.025). The Cox regression analysis showed that patients with CRAB bacteremia had 2.72 times higher risk for 30-day in-hospital mortality than did those with carbapenem-susceptible A. baumannii (CSAB) bacteremia (95% confidence intervals (CIs) 1.14–6.61, P=0.016). The logistic regression analysis reported that mechanical ventilation and respiratory tract as origin of bacteremia were independent predictors of mortality among patients with nosocomial A. baumannii bacteremia and CRAB bacteremia, while high APACHE II score on the day of bacteremia and multiple organ dysfunction syndromes (MODS) during hospitalization were independent predictors of mortality among patients with nosocomial A. baumannii bacteremia but not CRAB bacteremia. Conclusion It was the severity of illness (high APACHE II score and MODS) not carbapenem resistance that highlighted the mortality of patients with nosocomial A. baumannii bacteremia. The impact of mechanical ventilation on mortality suggested that respiratory dysfunction might prime the poor outcome. Protection of respiratory function during the progression of nosocomial A. baumannii bacteremia should be given more importance. Early identification and intervention of patients with nosocomial A. baumannii bacteremia in critical ill conditions were advocated.
Highlights
ICU was the main source of both nosocomial A. baumannii bacteremia (61/118, 51.7%) and carbapenem-resistant A. baumannii (CRAB) bacteremia (55/61, 90.2%), followed by neurosurgery department and hepatobiliary surgery department
Cummulative survival rate arbitrary to deduce that carbapenem resistance is the predictor for the mortality of A. baumannii bacteremia in nosocomial scenarios. erefore, we further evaluated the determinants of the mortality of nosocomial A. baumannii bacteremia (Table 1)
This study found that mechanical ventilation increased the risk of mortality of patients with nosocomial A. baumannii and CRAB bacteremia, which is consistent with other studies [11, 19, 25]
Summary
As a major nosocomial pathogen, carbapenem-resistant A. baumannii (CRAB) is of particular concern. Bloodstream infection caused by CRAB has been a more tremendous clinical challenge in consideration of the lack of effective antibiotic agents and high mortality [3,4,5,6]. Numerous data from different regions have elucidated risk factors for nosocomial colonization or infection of CRAB, whereas impact of nosocomial bacteremia with CRAB has not been well documented, especially in China, and there is ongoing controversy as to whether carbapenem resistance determines a higher mortality of A. baumannii bacteremia. The aim of this study was to identify the determinants of mortality for nosocomial A. baumannii bacteremia and further to illustrate the potential impact of carbapenem resistance on in-hospital mortality in this setting
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