Prior use of four invasive procedures increases the risk of Acinetobacter baumannii nosocomial bacteremia among patients in intensive care units: a systematic review and meta-analysis

Abstract

Background: Acinetobacter baumannii is considered a leading cause of nosocomial bloodstream infections in intensive care units (ICUs), but there is disagreement as to whether certain invasive ICU procedures increase the risk of this infection. To help address this question, we performed a systematic review of the literature on whether previous catheterization (central venous, arterial, and urinary), mechanical ventilation, nasogastric tube use, and abdominal or thoracic drainage are associated with the development of A. baumannii nosocomial bacteremia in ICUs.

Methods: Two reviewers searched PubMed, EMBASE, and Medline for the period January 1999 to February 2013. For each of seven invasive procedures, patients in the included studies were classified into two groups: those who had previously undergone that procedure and those who had not. The frequencies of A. baumannii nosocomial bacteremia were determined for each group.

Results: Five studies were included in the meta-analysis: three provided data for thoracic drainage, four for abdominal drainage, and five for the other invasive procedures. The following prior interventions were associated with an elevated risk of A. baumannii nosocomial bacteremia: mechanical ventilation (odds ratio (OR) 4.79, 95% confidence interval (CI) 3.09-7.43), central venous catheterization (OR 6.25, 95% CI 2.58-15.11), urinary catheterization (OR 2.55, 95% CI 1.49-4.36), and nasogastric tube use (OR 4.70, 95% CI 2.79-7.91).

Conclusions: Available evidence suggests that prior central venous or urinary catheterization, mechanical ventilation, and nasogastric tube use are associated with a higher risk of A. baumannii nosocomial bacteremia in the ICU.

Keywords: Acinetobacter baumannii; Bacteremia; Invasive procedures; Meta-analysis.