J Korean Med Sci.  2012 May;27(5):471-475. 10.3346/jkms.2012.27.5.471.

Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia: Impact of Appropriate Antimicrobial Therapy

• Kim YJ
• Kim SI
• Hong KW
• Kim YR
• Park YJ
• Kang MW

• KMID: 1372786
• DOI: http://doi.org/10.3346/jkms.2012.27.5.471

Abstract

This study investigated predictors associated with 14-day mortality, and focused especially on the impact of appropriate antimicrobial treatment among patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia. This retrospective study was performed at a tertiary care hospital in Korea from June 2007 to June 2010. Antibiotic therapy was considered appropriate if the antibiotics were administered via an appropriate route within 24 hr after the result of blood culture, had in vitro sensitivity to isolated strains, and of an adequate dosage according to the current guidelines. Ninety-five patients with A. baumannii bacteremia were included; of these, 53 (55.8%) were infected with CRAB. The overall infection-related 14-day mortality was higher in patients receiving inappropriate antimicrobial therapy than in patients receiving appropriate therapy (59.5% [22/37] vs 13.8% [8/58], P < 0.05). Multivariate analysis showed that septic shock (OR 10.5, 95% CI, 1.93-57.4; P = 0.006), carbapenem-resistance (OR 7.29, 95% CI 1.57-33.8; P = 0.01), pneumonia as a source of bacteremia (OR 5.29, 95% CI 1.07-26.1; P = 0.04), and inappropriate antimicrobial therapy (OR 8.05, 95% CI 1.65-39.2; P = 0.009) were independent risk factors for 14-day mortality. Early definite antimicrobial therapy had an influence on favorable outcomes in patients with A. baumannii bacteremia.

Keyword

Acinetobacter baumannii; Risk Factors; Carbapenem-Resistance; Mortality

MeSH Terms

APACHE
Acinetobacter Infections/drug therapy/microbiology/*mortality
Acinetobacter baumannii/drug effects/*isolation & purification
Adult
Age Factors
Aged
Anti-Bacterial Agents/*therapeutic use
Carbapenems/pharmacology
Diabetes Complications
Drug Resistance, Bacterial
Female
Humans
Male
Middle Aged
Odds Ratio
Pneumonia/etiology
Prognosis
Retrospective Studies
Risk Factors
Shock, Septic/etiology
Survival Rate

Figure

• 

  Fig. 1 Survival curve according to the appropriateness of antimicrobial therapy.

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