Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia
Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia
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DOI：
10.1016/j.jmii.2011.12.009
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发表时间：
2012-10-01
影响因子：
7.4
通讯作者：
Fung, Chang-Phone
中科院分区：
文献类型：
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作者：
Huang, Shih-Tse;Chiang, Mei-Chun;Fung, Chang-Phone
背景：耐碳青霉烯类鲍曼不动杆菌（CRAB）是否为死亡的独立危险因素仍有争议。本研究旨在确定CRAB菌血症患者与碳青霉烯类药物敏感的A。方法：本回顾性队列研究在台湾台北荣民总医院进行。A.结果：共纳入CRAB菌血症患者62例，CSAB菌血症患者164例。在这些患者中，获得CRAB菌血症的独立危险因素是血液恶性肿瘤[比值比（OR）：4.04; 95%置信区间（CI）：1.29-12.70; p = 0.017]，既往使用头孢吡肟（OR：2.60; 95% CI 1.11-6.08; p = 0.028）和使用全肠外营养（OR：3.06; 95% CI 1.12-8.39; p = 0.029）。CRAB菌血症患者的病死率高于CSAB菌血症患者。多因素分析显示，A.在鲍曼不动杆菌血症中，获得CRAB本身不是14天死亡率的独立危险因素。相反，预测14天死亡率的独立因素是急性生理学和慢性健康评估（APACHE）评分> 20（OR：6.33; 95% CI：2.32-17.26; p < 0.001），休克（OR：2.68; 95% CI：1.11-6.23; p = 0.025）和不适当的抗菌治疗结论：CRAB菌血症的危险因素为血液系统恶性肿瘤、既往使用头孢吡肟和使用全肠外营养。CRAB的获得本身并不是A型糖尿病患者的不良预后因素。鲍曼氏菌血症Copyright（c）2012，Taiwan Society of Microbiology.出版社：Elsevier Taiwan LLC All rights reserved.
Background: It is still controversial whether carbapenem-resistant Acinetobacter baumannii (CRAB) is an independent risk factor for mortality. This study aimed to determine the risk factors and outcomes of patients with CRAB bacteremia, compared to those with carbapenem-susceptible A. baumannii (CSAB) bacteremia.Methods: This retrospective cohort study was conducted in Taipei Veterans General Hospital, Taiwan. Patients with bacteremia due to A. baumannii during June 2002 and December 2007 were included.Results: A total of 62 patients with CRAB and 164 with CSAB bacteremia were included. Among these patients, the independent risk factors for acquiring CRAB bacteremia were hematological malignancy [odds ratio (OR): 4.04; 95% confidence interval (CI): 1.29-12.70; p = 0.017], previous use of cefepime (OR: 2.60; 95% CI 1.11-6.08; p = 0.028) and use of total parenteral nutrition (OR: 3.06; 95% CI 1.12-8.39; p = 0.029). The patients with CRAB bacteremia had higher mortality rate than those with CSAB bacteremia. However, multivariate analysis showed that among patients with A. baumannii bacteremia, acquisition of CRAB by itself was not an independent risk factor for 14-day mortality. Instead, the independent factors predicting14-day mortality were Acute Physiology and Chronic Health Evaluation (APACHE) score > 20 (OR: 6.33; 95% CI: 2.32-17.26; p < 0.001), shock (OR: 2.68; 95% CI: 1.11-6.23; p = 0.025) and inappropriate antimicrobial therapy (OR: 2.14; 95% CI: 1.01-4.53; p = 0.046).Conclusion: Risk factors for CRAB bacteremia were hematological malignancies, previous use of cefepime and use of total parenteral nutrition. Acquisition of CRAB itself is not a poor prognostic factor for the patients with A. baumannii bacteremia. Copyright (c) 2012, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved.