Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia.
Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia.
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DOI：
10.3389/fcimb.2017.00156
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发表时间：
2017
影响因子：
5.7
通讯作者：
Azar E
中科院分区：
文献类型：
--
作者：
Ballouz T;Aridi J;Afif C;Irani J;Lakis C;Nasreddine R;Azar E
鲍曼不动杆菌(AB)是一种日益流行的医院内致病菌，其感染具有较高的发病率和死亡率。我们进行了这项研究，以分析AB菌血症患者的临床特征、结果和影响患者生存的因素。我们回顾了2010至2015年间在贝鲁特一家三级护理医院住院期间发生AB菌血症的所有患者的医疗记录。在85名患者中记录了90次AB菌血症。单因素分析显示，既往接触大剂量类固醇、糖尿病、机械通气、既往使用粘菌素和替加环素、感染性休克和重症监护病房住院与不良预后相关。多因素分析显示，大剂量类固醇激素和感染性休克的发生具有统计学意义。粗死亡率为63.5%。70.3%的死亡归因于菌血症。在获取时，39名患者有败血症。尽管有很高的怀疑指数，并在18/39名患者中开始使用粘菌素和/或替格环素，但可怕的结果无法避免，37名患者在2.16天内死亡。7名患者有一过性良性菌血症；其中3名患者接受了切除管路的治疗。其余4人因放弃护理而没有接受任何抗生素治疗，并在感染菌血症后26.25天内死亡，随访中没有持续感染的迹象。长时间住院通常与功能丧失、类固醇和抗生素暴露有关。这些因素似乎影响了AB菌血症的死亡率，这是一种死亡率高、治疗选择有限的疾病。
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.