Risk factors for in-hospital death from nosocomial Acinetobacter baumannii bacteremia in intensive care units

• Main Authors: Hsueh-Lan Chao, 趙雪嵐
• Other Authors: 張志欽
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/42044150022789689198

碩士 === 高雄醫學大學 === 公共衛生學研究所碩士班 === 94 === Background: Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multi-drug resistant and is involved in various severe nosocomial infections with increased mobility and mortality, prolonged hospital stay and increased total cost. Objective: To investigate the risk factors for in-hospital death in patients with nosocomial A. baumannii bacteremia. Method: A retrospective case-control study. We performed a systematic review of all blood culture results from patients hospitalized in intensive care unit (ICU) between 2001 and 2005. A baumannii bacteremia and mortality data were recorded. Result: A total of 82 ICU patients, 57 males and 25 females with average age of 67 years old, were included in this study. The average total length of stay was 55±45.4 days. The average total length of stay before contracting blood-stream infection was 28±34.9 days. The average total length of stay in ICU before contracting blood-stream infection was 18±23.4 days. The average APACH II score for all the patients at the time of blood-stream infection were 27. 54.9% of the A. baumannii isolations were multi-drug resistant, 9.8% of them were pan-drug resistant. Antimicrobials were appropriately used in 62.2% of patients. A total of 42 (51.2%) patients died in the hospital. 20 of these patients could be attributed to A. baumannii infections. From univariate analysis, the risk factors for in-hospital death from blood stream A. baumannii infections were renal insufficiency (p=0.005), multi-drug resistant (p=0.001), organ failure (p=0.002), included heart failure (p=0.006), renal failure (p=0.001), hemato-organ failure (p=0.010) and liver failure (p=0.001) and multi-drug resistant Acinetobacter baumannii (p=0.001). By using multivariate analysis, risk factors that were independently correlated with in-hospital death from Acinetobacter baumannii infection were polycomibal infections (p=0.004), isolates with multi-drug resistance (p=0.001), and organ failure (p=0.010). Conclusion: Mortality from bloodstream infection of A. baumannii was demonstrated to be highly related to polymicrobial infections, isolates multi-drug resistance and organ failure. Keywords:Acinetobacter baumannii, nosocomial blood-stream infection multi-drug resistance, Pan-drug resistant.