Abstract
This retrospective observational study assessed the differences between monomicrobial and polymicrobial A. baumannii bacteremia and identified possible independent risk factors for 14-day mortality. There were 379 patients with A. baumannii bacteremia admitted to a tertiary care center in northern Taiwan between August 2008 and July 2015 enrolled for data analysis. Among them, 89 patients (23.5%) had polymicrobial bacteremia and 290 patients (76.5%) had monomicrobial bacteremia. No significant difference in 14-day mortality was observed between patients with monomicrobial and polymicrobial A. baumannii bacteremia (26.9% vs. 29.2%, p = 0.77). Logistic regression controlled for confounders demonstrated that polymicrobial bacteremia was not an independent predictor of mortality, whereas appropriate antimicrobial therapy was independently associated with reduced mortality. Higher 14-day mortality rates were observed in the polymicrobial bacteremic patients with concomitant isolation of Escherichia coli, Pseudomonas aeruginosa, and Enterobacter spp. from the bloodstream. Compared with patients with monomicrobial multidrug-resistant A. baumannii (MDRAb) bacteremia, those with MDRAb concomitant with Gram-negative bacilli bacteremia had a worse outcome. Polymicrobial A. baumannii bacteremia was not associated with a higher 14-day mortality rate than that of monomicrobial A. baumannii bacteremia, although more deaths were observed when certain Gram-negative bacteria were concomitantly isolated. Appropriate antimicrobial therapy remains an important life-saving measure for A. baumannii bacteremic patients.
Highlights
Polymicrobial bacteremia occurs in 6%–27.4% of patients with bloodstream infections and was first identified as an important problem in the 1960s for its higher attributable mortality rate compared with that for monomicrobial bacteremia [1,2,3,4]
In terms of the patients who died in hospital, those with polymicrobial A. baumanii bacteremia and monomicrobial A. baumanii bacteremia had a comparable hospital stay after the onset of bacteremia
We found that polymicrobial bacteremia was not an independent predictor of mortality, whereas appropriate antimicrobial therapy was independently associated with reduced mortality
Summary
Polymicrobial bacteremia occurs in 6%–27.4% of patients with bloodstream infections and was first identified as an important problem in the 1960s for its higher attributable mortality rate compared with that for monomicrobial bacteremia [1,2,3,4]. Bacteremia caused by A. baumannii occurs as polymicrobial infections in 19%–35% of cases [6,9,11,12]. No study has evaluated the impact of polymicrobial A. baumannii bacteremia on clinical outcomes. This retrospective observational study assessed whether polymicrobial infection was an independent risk factor for 14-day mortality in patients with A. baumannii bacteremia
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