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Published on: August 4, 2023
Outcomes of critically ill cancer patients with Acinetobacter baumannii infection
Silvio A Ñamendys-Silva1, Paulina Correa-García1, Francisco J García-Guillén1
1Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.
Aim:
To describe the intensive care unit (ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii (AB) infection.
Methods:
This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico (INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.
Results:
Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23 (4.6%) of whom developed AB infections. Sixteen (60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock (56.2%) and postoperative care (21.7%). The respiratory tract was the most frequent site of AB infection (91.3%). The most common organ dysfunction observed in our group of patients were the respiratory (100%), cardiovascular (100%), hepatic (73.9%) and renal dysfunction (65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7% (2/17) compared with 66.6% (4/6) for the group of patients with 4 or more organ system dysfunctions (P = 0.021). Multivariate analysis identified blood lactate levels (BLL) as the only variable independently associated with in-ICU death (OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.
Conclusion:
The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.
Insights
Critically ill cancer patients with Acinetobacter baumannii infections in the ICU face high mortality. Elevated blood lactate levels (BLL) on ICU admission are a key predictor of death.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Oncology
Background:
- Acinetobacter baumannii (AB) infections pose a significant threat to critically ill patients.
- Cancer patients in the intensive care unit (ICU) are particularly vulnerable to severe infections.
- Understanding ICU outcomes for cancer patients with AB infections is crucial for improving patient management.
Purpose of the Study:
- To describe the intensive care unit (ICU) outcomes of critically ill cancer patients diagnosed with Acinetobacter baumannii (AB) infection.
- To identify factors associated with mortality in this patient population.
Main Methods:
- An observational study was conducted at the National Cancer Institute of Mexico.
- Included 23 cancer patients who acquired AB infections during their ICU stay (2011-2012).
- Electronic health records were reviewed; patients with prior AB infections or infections within the first 2 days of ICU admission were excluded.
Main Results:
- Of 494 critically ill cancer patients admitted to the ICU, 23 (4.6%) developed AB infections, predominantly in those with hematologic malignancies (60.9%).
- The respiratory tract was the most common infection site (91.3%), with frequent organ dysfunction (respiratory, cardiovascular, hepatic, renal).
- ICU mortality was 26.1%, hospital mortality was 43.5%, and elevated blood lactate levels (BLL ≥ 2.6 mmol/L) were independently associated with in-ICU death (OR = 2.59).
Conclusions:
- Critically ill cancer patients with Acinetobacter baumannii infections admitted to the ICU experience high mortality rates.
- Increased organ system dysfunction significantly correlates with higher mortality.
- Blood lactate levels on the first day of ICU stay emerged as the strongest predictor of in-ICU mortality.
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