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. 2022 Mar 15;66(3):e0197521.
doi: 10.1128/AAC.01975-21. Epub 2022 Jan 10.

Treatment, Clinical Outcomes, and Predictors of Mortality among a National Cohort of Admitted Patients with Acinetobacter baumannii Infection

Haley J Appaneal  1   2   3 , Vrishali V Lopes  1 , Kerry L LaPlante  1   2   3   4 , Aisling R Caffrey  1   2   3   4
Affiliations

Treatment, Clinical Outcomes, and Predictors of Mortality among a National Cohort of Admitted Patients with Acinetobacter baumannii Infection

Haley J Appaneal et al. Antimicrob Agents Chemother. .

Abstract

The objectives were to analyze treatment, clinical outcomes, and predictors of mortality in hospitalized patients with Acinetobacter baumannii infection. This was a retrospective cohort study of inpatients with A. baumannii cultures and treatment from 2010 to 2019. Patients who died during admission were compared to those who survived, to identify predictors of inpatient mortality, using multivariable unconditional logistic regression models. We identified 4,599 inpatients with A. baumannii infection; 13.6% died during admission. Fluoroquinolones (26.8%), piperacillin-tazobactam (24%), and carbapenems (15.6%) were used for treatment. Tigecycline (3%) and polymyxins (3.7%) were not used often. Predictors of inpatient mortality included current acute respiratory failure (adjusted odds ratio [aOR] 3.94), shock (aOR 3.05), and acute renal failure (aOR 2.01); blood (aOR 1.94) and respiratory (aOR 1.64) infectious source; multidrug-resistant A. baumannii (MDRAB) infection (aOR 1.66); liver disease (aOR 2.15); and inadequate initial treatment (aOR 1.30). Inpatient mortality was higher in those with MDRAB versus non-MDRAB (aOR 1.61) and in those with CRAB versus non-CRAB infection (aOR 1.68). Length of stay >10 days was higher among those with MDRAB versus non-MDRAB (aOR 1.25) and in those with CRAB versus non-CRAB infection (aOR 1.31). In our national cohort of inpatients with A. baumannii infection, clinical outcomes were worse among those with MDRAB and/or CRAB infection. Predictors of inpatient mortality included several current conditions associated with severity, infectious source, underlying illness, and inappropriate treatment. Our study may assist health care providers in the early identification of admitted patients with A. baumannii infection who are at higher risk of death.

Keywords: Acinetobacter baumannii; antibiotic treatment; mortality; outcomes; predictors.

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Conflict of interest statement

The authors declare a conflict of interest. Haley Appaneal has received research funding from Shionogi. Kerry LaPlante has received research funding or acted as a scientific advisor for Merck, Parateck, Pfizer, Spero, and Shionogi. Aisling Caffrey has received research funding from Gilead, Merck, Pfizer, and Shionogi, and has received speaking honoraria from Merck. No other financial disclosures.

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