Prospective Study of Antibacterial Susceptibility, Risk Factors and Outcome of 157 Episodes of Acinetobacter baumannii Bacteremia in 1999 in Slovakia

Abstract

This study prospectively investigated all 157 cases of Acinetobacter baumannii bacteremia occurring in major university hospitals or tertiary care institutions in Slovakia during 1999 in order to determine the antimicrobial susceptibility, risk factors and outcome. Resistance to meropenem was 7.4, gentamicin 35.6, amikacin 26.5, cefepime 20.4 and ciprofloxacin 32.7%, but was only 17.3% to cefoperazone/sulbactam or ampicillin/sulbactam. Antimicrobial susceptibility of A. baumanii was lowest among isolates from cancer patients (ceftazidime 58%, piperacillin/tazobactam 52% and azthreonam 48%; p < or = 0.01-0.001). In univariate analysis, several risk factors, such as wound infection (p < or = 0.01) and ventilatory support (p < or = 0.0001), were significantly related to A. baumannii bacteremia in surgical patients. Neutropenia (p < or = 0.0001), antineoplastic chemotherapy (p < or = 0.0001) and prior antibiotic therapy (p < or = 0.0006) were significant risk factors for A. baumannii bacteremia in cancer patients. In addition, ventilatory support and surgery (p < or = 0.0001) and prior antibiotic therapy (p < or = 0.01) were significantly related to A. baumannii bacteremia in children. Colonization at other body sites (p < or = 0.05), diabetes mellitus (p < or = 0.04) and decubital ulcers/burns (p < or = 0.002) as underlying disease were significantly related to death due to A. baumannii bacteremia. In a multiple logistic regression model, decubital ulcers/burns as underlying disease (p < or = 0.0006; relative risk 5.08) and nosocomial pneumonia (p < or = 0.045; relative risk 5.08) were independent predictors of mortality. Mortality was similar between cancer and surgical patients but significantly lower in children vs. adults (p < or = 0.009).

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; in a Teaching Hospital from the United States

“…Diabetes and prior surgery, which were not significantly associated with overall resistance, were major risk factors in developing resistance in a second (or repeat) isolate. In our studies, many elderly patients who were hospitalized had a sacral decubitus ulcer, and were subsequently found to be infected [32]. These patients had come for a debridement procedure.…”

Diabetes Exacerbates Infection via Hyperinflammation by Signaling through TLR4 and RAGE

“…People with diabetes are three times more likely to develop bacterial sepsis and suffer far worse outcomes ( 2 – 5 ). In particular, diabetes is a risk factor for significantly increased mortality from infections caused by Gram-negative bacteria, especially Acinetobacter baumannii ( 6 – 9 ). Over a century of literature has indicated that defective phagocytes in diabetic hosts are responsible for worse outcomes from bacterial infections, leading to the characterization of diabetes as an immunosuppressive state.…”

Risk Factors for Bloodstream Infections Due to Acinetobacter spp.: A Prospective Case-Control Study

“…Eşlik eden hastalıklar Acinetobacter infeksiyonları için risk oluşturabilir ve bazı çalışmalarda kanser kemoterapisi almak Acinetobacter bakteriyemisi için risk faktörü olarak bulunmuştur (10,20). Bu çalışmada da kanser kemoterapisi almış olmak, olgu grubunda kontrol gruplarına göre daha yüksek oranda bulunmuştur.…”

“…Acinetobacter bakteriyemisi ve diğer etkenlerle gelişen bakteriyemilerin karşılaştırıldığı bir çalışmada ise kanser kemoterapisi değil ama immüno-süpresyon varlığı bir risk faktörü olarak bulunmuştur (13). Diyabetik hastalarda Acinetobacter infeksiyonlarında mortalitenin daha yüksek olduğu gösterilmiştir (20,21). Diyabet ve infeksiyonun edinilmesi arasındaki ilişki değerlendirildiğinde veriler çelişkili olup, bir çalışmada diyabetin diğer etkenlerin neden olduğu bakteriyemiler için risk oluşturduğu, Acinetobacter bakteriyemisi olan grupta daha az diyabetik hasta olduğu bildirilmiştir (13).…”