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Volume 38, Number 2, April 2005

Predictors of mortality in Acinetobacter baumannii bacteremia


Hsin-Pai Chen, Te-Li Chen, Chung-Hsu Lai, Chang-Phone Fung, Wing-Wai Wong, Kwok-Woon Yu, Cheng-Yi Liu
Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei; and Department Pathology and Laboratory Medicine, National Yang-Ming University, Taipei, Taiwan

Received: May 13, 2004    Revised: June 21, 2004    Accepted: July 30, 2004   

 

Corresponding author:

Dr. Chang-Phone Fung, Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan. E-mail: cpfung@vghtpe.gov.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Methods:

This study retrospectively investigated 149 episodes of Acinetobacter baumannii bacteremia which occurred during a 41-month period from September 1997 to January 2001. Bacteremia was nosocomial in 139 (93%) of the episodes and community-acquired in 10 (7%). Thirty three deaths (22.1%) were attributed to these episodes of A. baumannii bacteremia. The mean age of survivors was younger than that of patients who died of bacteremia (60.4 ± 19.9 vs 67.1 ± 17.4) but this result was not significant on univariate analysis (p=0.084). Previous intensive care unit stay was longer among survivors than among patients who died of bacteremia (9.5 vs 18 days, p=0.048). Factors associated with mortality included immunosuppression (p=0.019), shock (p=0.002), recent surgery (p=0.008), invasive procedures such as central venous catheterization (p=0.002), urinary catheterization (p=0.012), placement of a nasogastric tube (p<0.001), pulmonary catheterization (p=0.015), and mechanical ventilation (p=0.035). The number of underlying conditions (p=0.015) and invasive procedures (p<0.001) were positively correlated with mortality. Mortality was significantly associated with lower platelet count (p=0.001) and lower serum albumin concentration (p=0.005). Patients with catheter-related bacteremia had a high survival rate (96.2%), while survival rate was low in patients with infection originating from the respiratory tract (60.8%). Susceptibility testing by agar dilution test indicated that imipenem was the most effective antibiotic, followed by cefepime and ciprofloxacin. The mortality rate was lower in patients who received 1 or more antibiotics to which the isolates were susceptible, but this difference was not significant (p=0.197). On multivariate analysis, factors that independently correlated with mortality were increased age (p=0.003), immunosuppressive status (p=0.001), recent surgery (p=0.002), acute respiratory failure (p=0.004), acute renal failure (p=0.009) and septic shock (p<0.001). These findings highlight the importance of a treatment strategy based on risk stratification among patients with A. baumannii bacteremia.

 



 

Key words:

 

Acinetobacter baumannii, bacteremia, mortality, retrospective studies, risk factors



 



 

J Microbiol Immunol Infect 2005;38:127-136.