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Predictors of hospital mortality among septic ICU patients with Acinetobacter spp. bacteremia: a cohort study.

MedStar author(s):

1471-2334

Name of journal: BMC infectious diseasesAbstract: BACKGROUND: We hypothesized that among septic ICU patients with Acinetobacter spp. bacteremia (Ac-BSI), carbapenem-resistant Acinetobacter spp. (CRAc) increase risk for inappropriate initial antibiotic therapy (non-IAAT), and non-IAAT is a predictor of hospital death.CONCLUSIONS: Among septic ICU patients with Ac-BSI, non-IAAT predicts mortality. Carbapenem resistance appears to mediate the relationship between non-IAAT and mortality.METHODS: We conducted a retrospective cohort study of adult septic ICU patients with Ac-BSI. Non-IAAT was defined as exposure to initially prescribed antibiotics not active against the pathogen based on in vitro susceptibility testing, and having no exposure to appropriate antimicrobial treatment within 24 hours of drawing positive culture. We compared patients who died to those who survived, and derived regression models to identify predictors of hospital mortality and of non-IAAT.RESULTS: Out of 131 patients with Ac-BSI, 65 (49.6%) died (non-survivors, NS). NS were older (63 [51, 76] vs. 56 [45, 66] years, p=0.014), and sicker than survivors (S): APACHE II (24 [19, 31] vs. 18 [13, 22], p<0.001) and Charlson (5 [2, 8] vs. 3 [1, 6], p=0.009) scores. NS were also more likely than S to require pressors (75.4% vs. 42.4%, p<0.001) and mechanical ventilation (75.4% vs. 53.0%, p=0.008). Both CRAc (69.2% vs. 47.0%, p=0.010) and non-IAAT (83.1% vs. 59.1%, p=0.002) were more frequent among NS than S. In multivariate analyses, non-IAAT emerged as an independent predictor of hospital death (risk ratio [RR] 1.42, 95% confidence interval [CI] 1.10-1.58), while CRAc was the single strongest predictor of non-IAAT (RR 2.66, 95% CI 2.43-2.72).All authors: Kollef MH, Micek ST, Shorr AF, Zilberberg MDFiscal year: FY2015Digital Object Identifier:

http://dx.doi.org/10.1186/s12879-014-0572-6

Date added to catalog: 2016-01-13

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	25358621	Available		25358621

Available online from MWHC library: 2001 - present

BACKGROUND: We hypothesized that among septic ICU patients with Acinetobacter spp. bacteremia (Ac-BSI), carbapenem-resistant Acinetobacter spp. (CRAc) increase risk for inappropriate initial antibiotic therapy (non-IAAT), and non-IAAT is a predictor of hospital death.

CONCLUSIONS: Among septic ICU patients with Ac-BSI, non-IAAT predicts mortality. Carbapenem resistance appears to mediate the relationship between non-IAAT and mortality.

METHODS: We conducted a retrospective cohort study of adult septic ICU patients with Ac-BSI. Non-IAAT was defined as exposure to initially prescribed antibiotics not active against the pathogen based on in vitro susceptibility testing, and having no exposure to appropriate antimicrobial treatment within 24 hours of drawing positive culture. We compared patients who died to those who survived, and derived regression models to identify predictors of hospital mortality and of non-IAAT.

RESULTS: Out of 131 patients with Ac-BSI, 65 (49.6%) died (non-survivors, NS). NS were older (63 [51, 76] vs. 56 [45, 66] years, p=0.014), and sicker than survivors (S): APACHE II (24 [19, 31] vs. 18 [13, 22], p<0.001) and Charlson (5 [2, 8] vs. 3 [1, 6], p=0.009) scores. NS were also more likely than S to require pressors (75.4% vs. 42.4%, p<0.001) and mechanical ventilation (75.4% vs. 53.0%, p=0.008). Both CRAc (69.2% vs. 47.0%, p=0.010) and non-IAAT (83.1% vs. 59.1%, p=0.002) were more frequent among NS than S. In multivariate analyses, non-IAAT emerged as an independent predictor of hospital death (risk ratio [RR] 1.42, 95% confidence interval [CI] 1.10-1.58), while CRAc was the single strongest predictor of non-IAAT (RR 2.66, 95% CI 2.43-2.72).

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