Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the
Ji Ye Jung1, Moo Suk Park, Song Ee Kim
1Division of Pulmonology, Institute of Chest Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
Epidemic outbreaks of multi-drug resistant (MDR) Acinetobacter baumannii (AB) in intensive care units (ICUs) are increasing. The incidence of MDR AB bacteremia, which develops as a result of colonization, is increasing through widespread dissemination of the pathogen, and further colonization. We sought to determine risk factors for MDR AB bacteremia in patients colonized with MDR AB in the ICU.
Methods:
We conducted a retrospective, observational study of 200 patients colonized with MDR AB in the ICU at Severance Hospital, South Korea during the outbreak period between January 2008 and December 2009.
Results:
Of the 200 patients colonized with MDR AB, 108 developed MDR AB bacteremia, and 92 did not. APACHE II scores were higher in bacteremic than non-bacteremic patients at the time of ICU admission and colonization (24.0 vs. 21.6; P = 0.035, 22.9 vs. 16.8; P < 0.001, respectively). There was no difference between the two groups in the duration of time from ICU admission to colonization (7.1 vs. 7.2 days; P = 0.923), but the duration of time at risk was shorter in bacteremic patients (12.1 vs. 6.0 days; P = 0.016). A recent invasive procedure was a significant risk factor for development of bacteremia (odds ratio = 3.85; 95% CI 1.45-10.24; P = 0.007). Multivariate analysis indicated infection and respiratory failure at the time of ICU admission, maintenance of mechanical ventilation, maintenance of endotracheal tube instead of switching to a tracheostomy, recent central venous catheter insertion, bacteremia caused by other microorganism after colonization by MDR AB, and prior antimicrobial therapy, were significant risk factors for MDR AB bacteremia.
Conclusions:
Patients in the ICU, colonized with MDR AB, should be considered for minimizing invasive procedures and early removal of the invasive devices to prevent development of MDR AB bacteremia.
Insights
Multi-drug resistant Acinetobacter baumannii (MDR AB) bacteremia is a growing concern in intensive care units (ICUs). Minimizing invasive procedures and removing devices early can help prevent MDR AB bacteremia in colonized patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Rising incidence of multi-drug resistant (MDR) Acinetobacter baumannii (AB) outbreaks in intensive care units (ICUs).
- Increasing rates of MDR AB bacteremia, stemming from pathogen colonization and dissemination.
- Need to identify risk factors for MDR AB bacteremia in ICU patients already colonized with MDR AB.
Purpose of the Study:
- To determine risk factors associated with the development of MDR AB bacteremia in ICU patients colonized with MDR AB.
Main Methods:
- Retrospective, observational study involving 200 patients colonized with MDR AB in an ICU.
- Data collected during an outbreak period from January 2008 to December 2009.
- Comparison of characteristics between patients who developed bacteremia and those who did not.
Main Results:
- Higher APACHE II scores at ICU admission and colonization in bacteremic patients (P = 0.035 and P < 0.001, respectively).
- Shorter duration of time at risk for bacteremic patients (6.0 days vs. 12.1 days; P = 0.016).
- Significant risk factors for bacteremia included recent invasive procedures (OR = 3.85), infection/respiratory failure at ICU admission, mechanical ventilation, endotracheal tube use, central venous catheter insertion, other concurrent bacteremia, and prior antimicrobial therapy.
Conclusions:
- Patients colonized with MDR AB in the ICU are at significant risk for developing bacteremia.
- Minimizing invasive procedures and prompt removal of invasive devices are crucial preventive strategies.
- Early identification and management of risk factors can reduce the incidence of MDR AB bacteremia.
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