Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia

Liu, Chang-Pan; Shih, Shou‐Chuan; Wang, Naiyu; Wu, Alice Ying-Jung; Sun, Fang‐Ju; Chow, Shan-Fan; Chen, Te‐Li; Yan, Tsong‐Rong

doi:10.1016/j.jmii.2014.10.006

Cited by 50 publications

(44 citation statements)

References 33 publications

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“…In concordance with previous reports (Esterly et al, 2011; Chopra et al, 2013, 2014; Nutman et al, 2014; Fu et al, 2015; Gulen et al, 2015; Gu et al, 2016; Guo et al, 2016; Liu et al, 2016), we found that patients with compromised baseline mobility who are barely capable of carrying any life activities as by their ECOG, with longer hospital stay especially in the critical care units, with ≥1 mg/kg/day of steroids and antimicrobial exposure are at risk for AB bacteremia with poor outcome.…”

Section: Discussionsupporting

confidence: 93%

“…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). …”

Section: Introductionmentioning

confidence: 99%

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Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia

Ballouz

Aridi

Afif

et al. 2017

Front. Cell. Infect. Microbiol.

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia

Ballouz

Aridi

Afif

et al. 2017

Front. Cell. Infect. Microbiol.

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“…Given that the impact on mortality of VAP is related to its severity [21], the presence of concomitant A . baumannii bacteremia, whose crude mortality in the setting of pneumonia is high [22], can be understood as a key event that warns on severity and invasiveness of the VAP. A previous surgical procedure was more frequent in VAP than in colonized patients, but this feature was not associated to mortality in the whole sample (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

et al. 2016

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ObjectivesThis study aims to analyze the mortality and the length of ICU stay (LOS) of A. baumannii VAP compared to respiratory colonization in patients with mechanical ventilation (MV).MethodsA prospective cohort study was performed in an ICU of adult patients (February 2010–June 2011). One hundred patients on MV with A. baumannii in lower respiratory airways were recruited, and classified as VAP or airways colonization according to CPIS criteria, with a punctuation ≥6. LOS, 30-days mortality, A. baumannii bacteremia, and clinical features including antibiotic therapy were recorded. Multivariate analysis (linear and Cox regression) and survival analysis (Kaplan-Meier curves) were performed.ResultsFifty-seven VAP and 43 colonized A. baumannii patients were analyzed. Among the A. baumannii strains, 99% were non-susceptible to carbapenems and the MIC90 of colistin was 0.12 mg/l. Therapy was appropriate in 94.6% of VAP patients, most of them with colistin 6 MIU/day, although in 13 (23.6%) cases colistin was started 48 hours after the onset of VAP. Mortality was similar in both groups (VAP 24.6% vs. colonized 27.9%, p = 0.7). Bacteremia and acute kidney insufficiency were associated with decreased survival (p = 0.02 and p = 0.04, respectively) in VAP patients. LOS was 21.5 (11.5–42.75) vs. 9 (6–22) days for VAP and colonized patients (p = 0.004). VAP (p = 0.003) and age (p = 0.01) were independently related to a longer LOS.ConclusionsMultidrug-resistant A. baumannii VAP treated with colistin does not have a different mortality compared to lower airways colonization, among patients on mechanical-ventilation, in a setting of high susceptibility to colistin of A. baumannii.

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“…Several studies have consistently shown that bacteraemia caused by carbapenem-resistant isolates is associated with unacceptably high mortality when compared to bacteraemia caused by carbapenem-sensitive isolates (Kohler et al, 2017;Falagas et al, 2014;Daikos et al, 2014). In a study of mortality risk factors in 182 patients with carbapenem-resistant A. baumannii bacteraemia in Taiwan, the attributable mortality rate was 58% (Liu et al, 2016). In a retrospective observational study of a cohort of 118 patients with A. baumannii bacteraemia in Korea, the 30-day mortality rate was 34.1% and resistance to carbapenems was identified as one of the significant risk factors for mortality (Park et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and 30-day all-cause mortality of carbapenem-and colistin-resistant bacteraemia caused by Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae: Description of a decade-long trend

Balkhair

Al-Muharrmi

Al-Adawi

et al. 2019

International Journal of Infectious Diseases

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Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia

Cited by 50 publications

References 33 publications

Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia

Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia

Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

Prevalence and 30-day all-cause mortality of carbapenem-and colistin-resistant bacteraemia caused by Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae: Description of a decade-long trend

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