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

• Published in: Journal of Korean medical science Vol. 27; no. 5; pp. 471 - 475
• Main Authors: Kim, Youn Jeong, Kim, Sang Il, Hong, Kyung-Wook, Kim, Yang Ree, Park, Yeon Joon, Kang, Moon-Won
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.05.2012; 대한의학회
• Subjects: Acinetobacter baumannii - drug effects; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - drug therapy; Acinetobacter Infections - microbiology; Acinetobacter Infections - mortality; Adult; Age Factors; Aged; Anti-Bacterial Agents - therapeutic use; APACHE; Carbapenems - pharmacology; Diabetes Complications; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Odds Ratio; Original; Pneumonia - etiology; Prognosis; Retrospective Studies; Risk Factors; Shock, Septic - etiology; Survival Rate; 의학일반; Acinetobacter baumannii; Mortality; Risk Factors; Carbapenem-Resistance
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2012.27.5.471

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.