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Observational Study
. 2022 Feb 27:2022:5122085.
doi: 10.1155/2022/5122085. eCollection 2022.

Risk Factors for and Clinical Outcomes of Polymicrobial Acinetobacter baumannii Bloodstream Infections

Zhenhua Qian  1   2 , Shufang Zhang  3 , Na Li  4 , Weixing Ma  2 , Kai Zhang  1 , Feizhen Song  1   5 , Cheng Zheng  1   6 , Li Zhong  1   7 , Yesong Wang  1 , Jiachang Cai  8 , Hongwei Zhou  8 , Wei Cui  1 , Gensheng Zhang  1
Affiliations
Observational Study

Risk Factors for and Clinical Outcomes of Polymicrobial Acinetobacter baumannii Bloodstream Infections

Zhenhua Qian et al. Biomed Res Int. .

Abstract

Background: Although the clinical features of Acinetobacter baumannii bloodstream infection are well described, the specific clinical characteristics of polymicrobial Acinetobacter baumannii bloodstream infection have been rarely reported. The objective of this study was to examine the risk factors for and clinical outcomes of polymicrobial Acinetobacter baumannii bloodstream infection.

Methods: A retrospective observational study was performed from January 2013 to December 2018 in a tertiary hospital. All patients with Acinetobacter baumannii bloodstream infection were enrolled, and the data were collected from the electronic medical records.

Results: A total of 594 patients were included, 21% (126/594) of whom had polymicrobial infection. The most common copathogen was Klebsiella pneumoniae (20.81%), followed by Pseudomonas aeruginosa (16.78%) and Enterococcus faecium (12.08%). Compared with monomicrobial Acinetobacter baumannii bloodstream infection, polymicrobial Acinetobacter baumannii bloodstream infection mostly originated from the skin and soft tissue (28.6% vs. 10.5%, p < 0.001). Multivariate analysis revealed that burn injury was independently associated with polymicrobial Acinetobacter baumannii bloodstream infection (adjusted odds ratio, 3.569; 95% confidence interval, 1.954-6.516). Patients with polymicrobial Acinetobacter baumannii bloodstream infection were more likely to have a longer hospital length of stay [40 (21, 68) vs. 27 (16, 45), p < 0.001] and more hospitalization days after bloodstream infection than those with monomicrobial Acinetobacter baumannii bloodstream infection [22 (8, 50) vs. 13 (4, 28), p < 0.001]. However, no significant difference in mortality was observed between the two groups.

Conclusions: Approximately one-fifth of Acinetobacter baumannii bloodstream infections were polymicrobial in this cohort. The main sources were skin and soft tissue infections, and burn injury was the only independent risk factor. Although mortality did not differ between the groups, considering the limitations of the study, further studies are required to assess the impact of polymicrobial (vs. monomicrobial) Acinetobacter baumannii bloodstream infection on outcomes.

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Conflict of interest statement

The authors declare that there are no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of study participant enrollment. Abbreviations: AB-BSI: Acinetobacter baumannii bloodstream infection.
Figure 2
Figure 2
Distributions of coinfecting organisms in polymicrobial Acinetobacter baumannii bloodstream infections. Fungi: Candida albicans, Candida near smooth, and Candida tropicalis; others: Escherichia coli, Proteus mirabilis, Enterobacter cloacae, Serratia marcescens, etc.; Abbreviations: AB-BSI: Acinetobacter baumannii bloodstream infection.
Figure 3
Figure 3
Kaplan-Meier estimates of 14-day survival in patients with polymicrobial AB-BSI and monomicrobial AB-BSI; Abbreviations: AB-BSI: Acinetobacter baumannii bloodstream infection.
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