Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

doi:10.5847/wjem.j.1920-8642.2020.03.006

Abstract

Abstract:

BACKGROUND: Acinetobacter baumannii (AB) bacteremia is an increasingly common and often fatal nosocomial infection. Identification of morbidity and mortality risk factors for AB bacteremia in emergency department (ED) patients may provide ways to improve the clinical outcomes of these patients.

METHODS: The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a single-center ED. Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.

RESULTS: A significant risk factor for morbidity was the presence of a central venous catheter (CVC) (P<0.001). The mortality rate for the 51 patients with AB bacteremia was 68.6%. Risk factors for mortality were the presence of a CVC (P=0.021) and an ED stay longer than two weeks (P=0.015).

CONCLUSION: AB infections lead to high morbidity and mortality. The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia. Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

Key words: Acinetobacter baumannii, Bacteremia, Morbidity, Mortality

Rui-xue Sun, Priscilla Song, Joseph Walline, He Wang, Ying-chun Xu, Hua-dong Zhu, Xue-zhong Yu, Jun Xu. Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia[J]. World Journal of Emergency Medicine, 2020, 11(3): 164-168.

Figures/Tables 3

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Parameters	Control group (n=51)	Case group (n=51)	P
Diabetes	6 (11.8)	10 (19.6)	0.276
Tumor	10 (19.6)	6 (11.8)	0.276
Autoimmune disease	10 (19.6)	6 (11.8)	0.276
Smoking history	14 (27.5)	17 (33.3)	0.518
Drinking history	8 (15.7)	6 (11.8)	0.565
Central venous catheter	19 (37.3)	41 (80.4)	0.000
Ventilator	21 (41.2)	30 (58.8)	0.075
Corticosteroid use	15 (29.4)	14 (27.5)	0.826
Carbapenems use	27 (52.9)	38 (74.5)	0.023

Parameters	Mortality (n=35)	Survival (n=16)	P
Gender
Female	18 (51.4)	4 (25.0)
Male	17 (48.6)	12 (75.0)	0.077
Age
>60 years old	18 (51.4)	10 (62.5)	0.461
Hospitalization time
>2 weeks	12 (34.3)	12 (75.0)	0.007
ICU	24 (68.6)	11 (68.8)	0.990
Main diagnosis
Pulmonary infection	20 (57.1)	6 (37.5)	0.193
Underlying diseases
Hypertension	9 (25.7)	6 (37.5)	0.599
Diabetes	9 (25.7)	1 (6.3)	0.213
Tumor	4 (11.4)	2 (12.6)	>0.999
SLE	2 (5.7)	0 (0.0)	>0.999
Smoking history	9 (25.7)	8 (50.0)	0.088
Drinking history	5 (14.3)	1 (6.3)	0.720
Coma	12 (34.3)	6 (37.5)	0.824
Central venous catheter	32 (91.4)	9 (56.3)	0.011
Ventilator	22 (62.9)	8 (50.0)	0.387
Corticosteroid use	12 (34.3)	2 (12.5)	0.201
Exposure to antibiotic therapy
Imipenem use	21 (60.0)	9 (56.3)	0.801
Ceftazidime use	6 (17.1)	4 (25.0)	0.783
Co-infection with other pathogens	5 (14.3)	6 (37.5)	0.147
Antibiotic susceptibility
Tigecycline	15 (42.9)	6 (37.5)	0.718
Minocycline	25 (71.4)	7 (43.8)	0.058
Cefperazone-Sulbactam	0 (0.0)	1 (6.3)	0.314
Appropriate antimicrobial therapy	11 (31.4)	8 (50.0)	0.203

Parameters	P	OR	95% CI
>2 weeks	0.015	6.412	1.429-28.766
Central venous catheter	0.021	0.132	0.023-0.741

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