Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit

Abstract

To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.

Keywords: Acinetobacter baumannii; Bacteremia; Drug Resistance, Multiple; Intensive Care Units; Mortality; Risk Factors.

Fig. 1

Outline of study design. ICU, intensive care unit; CRAB, carbapenem-resistant Acinetobacter baumannii ; CSAB, carbapenem-sensitive Acinetobacter baumannii.

Fig. 2

Trends of incidence of CRAB bacteremia after 1 yr of CRAB reduction activity. CRAB, carbapenem-resistant Acinetobacter baumannii ; ICU, intensive care unit.

Fig. 3

Finger print polymerase chain reactions of CRAB from patients (A) and the ICU environment (B). CRAB, carbapenem-resistant Acinetobacter baumannii; ICU, intensive care unit.