Abstract
Infections caused by Acinetobacter baumannii (AB), an increasingly prevalent nosocomial pathogen, have been associated with high morbidity and mortality. We conducted this study to analyze the clinical features, outcomes, and factors influencing the survival of patients with AB bacteremia. We retrospectively examined the medical records of all patients developing AB bacteremia during their hospital stay at a tertiary care hospital in Beirut between 2010 and 2015. Ninety episodes of AB bacteremia were documented in eighty-five patients. Univariate analysis showed that prior exposure to high dose steroids, diabetes mellitus, mechanical ventilation, prior use of colistin and tigecycline, presence of septic shock, and critical care unit stay were associated with a poor outcome. High dose steroids and presence of septic shock were significant on multivariate analysis. Crude mortality rate was 63.5%. 70.3% of the deaths were attributed to the bacteremia. On acquisition, 39 patients had septicemia. Despite high index of suspicion and initiation of colistin and/or tigecycline in 18/39 patients, a grim outcome could not be averted and 37 patients died within 2.16 days. Seven patients had transient benign bacteremia; three of which were treated with removal of the line. The remaining four did not receive any antibiotics due to withdrawal of care and died within 26.25 days of acquiring the bacteremia, with no signs of persistent infection on follow up. A prolonged hospital stay is frequently associated with loss of functionality, and steroid and antibiotic exposure. These factors seem to impact the mortality of AB bacteremia, a disease with high mortality rate and limited therapeutic options.
Highlights
Acinetobacter baumannii (AB) is an aerobic non-fermenting gram-negative Coccobacillus, emerging as a prominent nosocomial pathogen with enhanced environmental resilience and propensity to develop resistance to commonly prescribed antimicrobials
Of particular importance is the ability of Acinetobacter to cause blood stream infections, especially in critically ill patients, the clinical course of which may range from a benign transient bacteremia to fulminant septic shock (Seifert et al, 1995)
Previous studies have demonstrated that crude mortality rates in patients with AB bacteremia varied between 30 and 76%, and factors associated with worse prognosis include immunosuppression (Gulen et al, 2015; Townsend et al, 2015; Gu et al, 2016), drug resistance (Lee et al, 2007; Sunenshine et al, 2007; Fu et al, 2015; Guo et al, 2016), severity of underlying illness (Seifert et al, 1995; Chopra et al, 2013, 2014; Nutman et al, 2014), inappropriate antimicrobial therapy (Esterly et al, 2011; Huang et al, 2012; Shorr et al, 2014; Freire et al, 2016), septicemia (Huang et al, 2012; Ñamendys-Silva et al, 2015; Freire et al, 2016), and prior antibiotic exposure (Chopra et al, 2013, 2014; Gu et al, 2016; Liu et al, 2016)
Summary
Acinetobacter baumannii (AB) is an aerobic non-fermenting gram-negative Coccobacillus, emerging as a prominent nosocomial pathogen with enhanced environmental resilience and propensity to develop resistance to commonly prescribed antimicrobials. Infections caused by AB include blood stream infections, ventilator associated pneumonias, urinary tract infections, meningitis, and wound infections (Munoz-Price and Weinstein, 2008). These infections are associated with high morbidity and mortality and contribute to a prolonged hospital stay and high hospital costs (Lee et al, 2007; Sunenshine et al, 2007; Jang et al, 2009; Asim et al, 2016). We conducted this study to analyze the clinical outcomes and risk factors predicting mortality in patients with Acinetobacter bacteremia
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