Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes.
Journal - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Germany )
We conducted a retrospective matched cohort study to examine the impact of isolation of multi-drug-resistant (MDR) Acinetobacter baumannii on patient outcomes. Cases from whom MDR A. baumannii was isolated in a clinical culture (n = 118) were compared with controls from whom MDR A. baumannii was not isolated (n = 118). Cases and controls were matched according to ward, calendar month of hospitalization, and duration of hospitalization before culture. The following outcomes were compared in multivariable analysis: in-hospital mortality, length of stay, need for mechanical ventilation, and functional status at discharge. MDR A. baumannii was determined to be a pathogen in 72% of cases. In 36% of cases, the patient died, versus 21% of controls (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.17-4.16, P = 0.014). Median length of stay for surviving cases was 17 days, versus 11 for surviving controls (multiplicative effect 1.55, 95% CI 0.99-2.44, P = 0.057). Fifty-two percent of cases required mechanical ventilation, versus 25% of controls (OR 3.72, 95% CI 1.91-7.25, P<0.001); 60% of surviving cases were discharged with reduced functional status, versus 38% of controls (OR 4.4, 95% CI 1.66-11.61, P = 0.003). In multivariable analysis, clinical isolation of MDR A. baumannii remained a significant predictor of mortality (OR 6.23, 95% CI 1.31-29.5, P = 0.021), need for mechanical ventilation (OR 7.34, 95% CI 2.24-24.0, P<0.001), and reduced functional status on discharge (OR 7.93, 95% CI 1.1-56.85, P = 0.039). Thus, MDR A. baumannii acquisition is associated with severe adverse outcomes, including increased mortality, need for mechanical ventilation, and reduced functional status.
|ISSN : ||0934-9723|
|Mesh Heading : ||Acinetobacter Infections Acinetobacter baumannii Aged Case-Control Studies Consciousness Female Humans Length of Stay Male Multivariate Analysis Prognosis Respiration, Artificial Retrospective Studies Treatment Outcome drug therapy mortality isolation & purification|
|Mesh Heading Relevant : ||Drug Resistance, Multiple, Bacterial microbiology drug effects|
Multidrug-resistant Acinetobacter baumannii.
Journal - Emerging infectious diseases (United States )
To understand the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii and define individual risk factors for multidrug resistance, we used epidemiologic methods, performed organism typing by pulsed-field gel electrophoresis (PFGE), and conducted a matched case-control retrospective study. We investigated 118 patients, on 27 wards in Israel, in whom MDR A. baumannii was isolated from clinical cultures. Each case-patient had a control without MDR A. baumannii and was matched for hospital length of stay, ward, and calendar time. The epidemiologic investigation found small clusters of up to 6 patients each with no common identified source. Ten different PFGE clones were found, of which 2 dominated. The PFGE pattern differed within temporospatial clusters, and antimicrobial drug susceptibility patterns varied within and between clones. Multivariate analysis identified the following significant risk factors: male sex, cardiovascular disease, having undergone mechanical ventilation, and having been treated with antimicrobial drugs (particularly metronidazole). Penicillins were protective. The complex epidemiology may explain why the emergence of MDR A. baumannii is difficult to control.
|ISSN : ||1080-6040|
|Mesh Heading : ||Acinetobacter Infections Acinetobacter baumannii Aged Aged, 80 and over Case-Control Studies Communicable Diseases, Emerging Cross Infection Electrophoresis, Gel, Pulsed-Field Female Humans Israel Male Microbial Sensitivity Tests Middle Aged Retrospective Studies Risk Factors microbiology classification genetics microbiology microbiology epidemiology|
|Mesh Heading Relevant : ||Drug Resistance, Multiple, Bacterial Hospitals, Teaching epidemiology drug effects epidemiology epidemiology|