Predictors of Acute Kidney Injury and 28-Day Mortality in Carbapenem-Resistant <i>Acinetobacter baumannii</i> Complex Bacteremia

Yu, Shi Nae; Kim, Tark; Park, Se Yoon; Lee, Yu Mi; Park, Ki Ho; Lee, Eun Jung; Jeon, Min Hyok; Choo, Eun Ju; Kim, Tae Hyong; Lee, Mi Suk; Park, Seong Yeon

doi:10.1089/mdr.2020.0312

Cited by 8 publications

(6 citation statements)

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“…BSI is associated with a high complication rate among severely ill patients, including those with AKI, which is a complication of critical illness that has long been recognized as being independently associated with mortality. 34 , 35 Our study reached a consistent conclusion that AKI is one of the major complications among all immunosuppressed patients and that the occurrence of AKI remarkably increases mortality. Furthermore, AKI development was a significant prognostic risk factor in the ICU admission and septic shock subgroups ( Table 4 , Supplementary Table 1 ).…”

Section: Discussionsupporting

confidence: 76%

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Gao¹,

Xu²,

Yao³

et al. 2022

IDR

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Purpose Carbapenem-resistant Gram-negative bacteria bloodstream infection (CRGNB-BSI) has gradually become a major threat worldwide due to its treatment difficulty and high mortality. This study aimed to determine the risk factors for CRGNB-BSI in immunosuppressed patients. Patients and Methods A total of 427 immunosuppressed patients with CRGNB-BSI were retrospectively investigated from 2015 to 2021. Both univariate and multivariate logistic regression analyses were applied to evaluate independent risk factors for CRGNB-BSI. Results The most common etiology was Klebsiella Pneumoniae (50.59%; 216/427), while the Acinetobacillus baumannii infection was associated with the highest mortality (58.25%) among all etiologies. The 60-day mortality of immunosuppressed patients with CRGNB-BSI was 52.48% (224/427). Procalcitonin (PCT) > 0.5 μg/L (OR = 2.32, 95% CI: 1.28–4.19, P = 0.005) and age > 55 years (OR = 2.06, 95% CI: 1.17–3.64, P = 0.012) were found to be predictors of 60-day mortality of CRGNB-BSI, and tigecycline regimen (OR = 3.20, 95% CI: 1.81–5.67, P < 0.001) was associated with higher mortality. Multivariate analysis also revealed that patients who developed acute kidney injury (AKI) (OR = 2.19, 95% CI: 1.11–4.30, P = 0.023), gastrointestinal bleeding (OR = 3.18, 95% CI: 1.10–9.16, P = 0.032), multiple organ dysfunction syndrome (MODS) (OR = 12.11, 95% CI: 2.61–56.19, P = 0.001), and septic shock (OR = 3.24, 95% CI: 1.77–5.94, P < 0.001) showed worse outcomes. The risk factors were also significantly associated with mortality in the different subgroups. Conclusion This study demonstrated that PCT > 0.5 μg/L, age > 55 years, and the tigecycline regimen were significantly associated with higher 60-day mortality among immunosuppressed patients with CRGNB- BSI. Patients developing MODS, septic shock, or AKI had worse clinical outcomes.

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Section: Discussionsupporting

confidence: 76%

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Gao¹,

Xu²,

Yao³

et al. 2022

IDR

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“…Three recent studies all found that a high Pitt bacteremia score was an independent risk factor for ABC bacteremia-related mortality [10,12,25] . Moreover, [14,26] . Liat et al found that, to be a protective factor, appropriate antibiotic therapy must be started within 48 hours [27] .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is necessary to investigate changes in the prevalence, microbiological characteristics, treatments, and prognosis in a local context. Reported risk factors for mortality in patients with ABC bacteremia include old age, malignancy, acute kidney injury, septic shock, ICU stay, previous antibiotic use, and illness severity, as de ned by the Pitt bacteremia, Acute Physiology and Chronic Health Evaluation II (APACHE II) or Sequential Organ Failure Assessment (SOFA) score, Charlson comorbidity index > 3, lower albumin levels, respiratory tract as the origin of bacteremia, carbapenem resistance, and inappropriate initial antimicrobial therapy [5,[10][11][12][13][14] . Studies have suggested that a respiratory tract bacteremia origin may be an independent risk factor for mortality [12,15] , although other studies have refuted this.…”

Section: Introductionmentioning

confidence: 99%

A 12-year retrospective single-center comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii complex bacteremia

Xia

2022

Preprint

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Background Acinetobacter baumannii complex (ABC) is a group of increasingly prevalent opportunistic pathogens that cause a variety of life-threatening nosocomial infections, especially in the intensive care unit (ICU). It is unclear whether ABC bacteremia differs with infection site. This study assessed the differences between pneumonia- and non-pneumonia-related ABC bacteremia and possible independent risk factors for 30-day mortality. Methods The clinical data of 188 patients diagnosed with ABC bacteremia in our 29-bed ICU between January 2009 and December 2020 were collected. Of these, 44 cases (23.4%) were defined as pneumonia-related ABC bacteremia and 144 (76.6%) as non-pneumonia-related ABC bacteremia. Results Significant changes in the incidence of ABC bacteremia and antibiotic resistance were observed over the 12-year study, with an overall 30-day mortality rate of 61.7%. Compared with non-pneumonia-related ABC bacteremia, pneumonia-related ABC bacteremia was associated with a higher rate of hypertension, less prior tigecycline use, more carbapenem-resistant (CR) strains, and had a higher 30-day mortality rate. Univariate analysis showed that hematological malignancy, previous corticosteroid use, prior exposure to quinolone and anti-fungal agents, CR strains, monomicrobial bacteremia, respiratory tract bacteremia origin, lower albumin and higher lactate levels at the time of bacteremia, immunosuppression, septic shock, and severity of illness based on the Pitt bacteremia score, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) scores at the time of bacteremia were associated with poor outcomes. In multivariate analysis, immunosuppression, and higher APACHE II and SOFA scores, were risk factors for 30-day mortality. Moreover, the risk of death was 1.919 times higher in the pneumonia-related group. Conclusions Our study described the clinical characteristics and independent predictors of 30-day mortality in patients with pneumonia- and non-pneumonia-related ABC bacteremia. Although pneumonia-related ABC bacteremia had worse outcomes, it was not an independent risk factor for death statistically. Detection of immune status and maintenance of organ function may be effective therapeutic strategies to improve patient outcomes.

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“…A previous systematic review and meta-analysis including 10 studies reported that the pooled mortality of patients with ABCBSI was ~56.3% ( Du et al, 2019 ). The mortality risks for ABCBSI include old age, malignancy, chronic renal disease, chronic liver disease, neutropenia, septic shock, immunosuppressant use, total parenteral nutrition, ICU stay, previous antibiotic use, Pitt bacteremia score, APACHE II score, SOFA score, lower albumin levels, bacteremia origin, carbapenem resistance, and inappropriate initial antimicrobial therapy ( Du et al, 2019 ; Russo et al, 2019 ; Zhou et al, 2019 ; Son et al, 2020 ; Gu et al, 2021 ; Yu et al, 2021 ). However, previous studies mainly focused on testing hypotheses involving causal relationships and the predictive effect of conventional regression analysis methods may be unsatisfactory because it is mainly used to solve linear problems and is difficult to fit the real distribution of data.…”

Section: Discussionmentioning

confidence: 99%

Acinetobacter baumannii complex-caused bloodstream infection in ICU during a 12-year period: Predicting fulminant sepsis by interpretable machine learning

Chen²,

Zheng³

2022

Front. Microbiol.

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BackgroundAcinetobacter baumannii complex-caused bloodstream infection (ABCBSI) is a potentially fatal infection in intensive care units (ICUs). This study proposed an interpretable machine learning (ML) model to predict ABCBSI fulminant fatality.MethodsA retrospective study of ICU patients with ABCBSI was performed in China from 2009 to 2020. Patients were stratified into two groups: those that suffered from fulminant sepsis and died within 48 h, and those that survived for more than 48 h. The clinical score systems and ML models with Shapley additive explanation (SHAP) were used to develop the prediction models. The ML model was internally validated with five-fold cross-validation, and its performance was assessed using seven typical evaluation indices. The top 20 features ranked by the SHAP scores were also calculated.ResultsAmong 188 ICU patients with ABCBSI, 53 were assigned to the non-survival group and 135 to the survival group. The XGBoost model exhibited the greatest area under the receiver operating characteristic curve (AUC), which outperformed other models (logistic regression, AUC = 0.914; support vector machine, AUC = 0.895; random forest, AUC = 0.972; and naive Bayesian, AUC = 0.908) and clinical scores (Acute Physiology and Chronic Health Evaluation II (APACHE II), AUC = 0.855; Sequential Organ Failure Assessment (SOFA), AUC = 0.837). It also had a sensitivity of 0.868, a specificity of 0.970, an accuracy of 0.941, a positive predictive value of 0.920, a negative predictive value of 0.949, and an F1 score of 0.893. As well as identifying the top 12 different important predictors that contribute to early mortality, it also assessed their quantitative contribution and noteworthy thresholds.ConclusionBased on the XGBoost model, early mortality in ABCBSI is estimated to be more reliable than other models and clinical scores. The 12 most important features with corresponding thresholds were identified and more importantly, the SHAP method can be used to interpret this predictive model and support individual patient treatment strategies.

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Predictors of Acute Kidney Injury and 28-Day Mortality in Carbapenem-Resistant Acinetobacter baumannii Complex Bacteremia

Cited by 8 publications

References 40 publications

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

A 12-year retrospective single-center comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii complex bacteremia

Acinetobacter baumannii complex-caused bloodstream infection in ICU during a 12-year period: Predicting fulminant sepsis by interpretable machine learning

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