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Medline ® Abstract for Reference 86

of 'Acinetobacter infection: Epidemiology, microbiology, pathogenesis, clinical features, and diagnosis'

Attributable mortality of nosocomial Acinetobacter bacteremia.
Grupper M, Sprecher H, Mashiach T, Finkelstein R
Infect Control Hosp Epidemiol. 2007;28(3):293. Epub 2007 Feb 7.
OBJECTIVE: To determine the attributable mortality and outcome of nosocomial Acinetobacter bacteremia.
DESIGN: Matched, retrospective cohort study.
SETTING: Large, university-based, tertiary care center.
PATIENTS: Of 219 patients with nosocomial Acinetobacter bacteremia identified by prospective surveillance during a 3-year period, 52 met the criteria for the study and were matched to a control patient by age, sex, primary and secondary diagnosis, operative procedures, and date of admission.
RESULTS: A 100% success rate was achieved in the proportion of case patients and control patients matched for the compared criteria, except for major operative procedures (88%) and the presence of an important secondary underlying disease (54.5%). Twenty-nine (55.7%) of the case patients died, compared with 10 (19.2%) of the control patients (P<.001). The attributable mortality was 36.5% (95% CI, 27%-46%) and the risk ratio for death was 2.9 (95% CI, 1.58-5.32). In a multivariate survival analysis, older age, mechanical ventilation, renal failure, and Acinetobacter bacteremia (hazard ratio [HR], 4.41; 95% confidence interval [CI], 1.97-9.87; P<.001) were found to be independent predictors of mortality. There was a trend for a longer median duration of hospitalization among case patients, compared with control patients (11.5 vs. 6.5 days; P=.06). Three isolates were resistant to all but 1 antibiotic tested (colistin), and 45 isolates (86.5%) were resistant to 4 or more different antibiotic classes.
CONCLUSIONS: When adjusted for risk-exposure time and severity of disease at admission, nosocomial Acinetobacter bacteremia is associated with mortality in excess of that caused by the underlying diseases alone.
Infectious Diseases Unit, Rambam Medical Center, 31096-Bat Galim, Haifa, Israel.