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. 2023 Aug 10;5(4):dlad096.
doi: 10.1093/jacamr/dlad096. eCollection 2023 Aug.

Risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infections and related mortality in critically ill patients with CRAB colonization

Francesco Cogliati Dezza  1 , Sara Covino  1 , Flavia Petrucci  1 , Federica Sacco  2 , Agnese Viscido  2 , Francesca Gavaruzzi  1 , Giancarlo Ceccarelli  1 , Gianmarco Raponi  2 , Cristian Borrazzo  3 , Francesco Alessandri  4 , Claudio Maria Mastroianni  1 , Mario Venditti  1 , Alessandra Oliva  1
Affiliations

Risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infections and related mortality in critically ill patients with CRAB colonization

Francesco Cogliati Dezza et al. JAC Antimicrob Resist. .

Abstract

Background: Among MDR bacteria, carbapenem-resistant Acinetobacter baumannii (CRAB) is a major concern due to the limited therapeutic options. During the COVID-19 pandemic, a worrying increase in the spread of CRAB infections was reported.

Objectives: The study assessed the risk factors for CRAB bloodstream infection (BSI) in patients admitted to the ICU with CRAB colonization, and the related mortality risk factors.

Methods: We conducted a single-centre, observational, prospective study; all consecutive patients with CRAB colonization admitted to the ICU of a tertiary hospital in Rome from January 2021 to September 2022 were included in the study. Univariate and multivariate analyses were performed to investigate BSI and mortality risk factors.

Results: Overall, 129 patients were included in the study; 57 (44%) out of these developed BSI. In our study population, at the multivariable analysis the Charlson comorbidity index (CCI) (P = 0.026), COVID-19 (P < 0.001), multisite colonization (P = 0.016) and the need for mechanical ventilation (P = 0.024) were risk factors independently associated with BSI development. Furthermore, age (P = 0.026), CCI (P < 0.001), septic shock (P = 0.001) and Pitt score (P < 0.001) were independently associated with mortality in the BSI patients. Instead, early appropriate therapy (P = 0.002) and clinical improvement within 72 h (P = 0.011) were shown to be protective factors.

Conclusions: In critically ill patients colonized by CRAB, higher CCI, multisite colonization and the need for mechanical ventilation were identified as risk factors for BSI onset. These predictors could be useful to identify patients at highest risk of BSI.

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Figures

Figure 1.
Figure 1.
Flow chart of study population.
Figure 2.
Figure 2.
Cumulative proportions of all-cause 28 day (a) and overall (b) in-hospital mortality. The cumulative proportions of in-hospital mortality were estimated from CRAB colonization between colonized-only patients (no BSI) and BSI patients (BSI).
Figure 3.
Figure 3.
CRAB colonization in BSI patients. (a) Timing from colonization to BSI onset in the BSI patients group. (b) Relationship between single versus multisite colonization in the no BSI patients and BSI patients. * P < 0.05.
See this image and copyright information in PMC

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