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Medline ® Abstract for Reference 86

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

86
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Attributable mortality of nosocomial Acinetobacter bacteremia.
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Grupper M, Sprecher H, Mashiach T, Finkelstein R
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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.
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Infectious Diseases Unit, Rambam Medical Center, 31096-Bat Galim, Haifa, Israel.
PMID