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Impact of an Acinetobacter baumannii outbreak on kidney events in a burn unit: A targeted machine learning analysis

Thomas Vauchel1, Romain Pirracchio2, Maïté Chaussard3

  • 1AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France.

American Journal of Infection Control
|December 4, 2018
PubMed
Abstract

Insights

An imipenem-resistant Acinetobacter baumannii (IR-AB) outbreak increased kidney injury risk in ICU patients. Colistin use was identified as a significant driver of these adverse renal outcomes.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Critical Care Medicine

Background:

  • Multidrug-resistant (MDR) bacteria outbreaks, particularly imipenem-resistant Acinetobacter baumannii (IR-AB), pose significant threats in intensive care units (ICUs).
  • Such outbreaks can lead to increased patient exposure to direct drug toxicity, potentially impacting organ function.

Purpose of the Study:

  • To investigate the impact of an IR-AB outbreak on renal outcomes in a burn intensive care unit.
  • To identify factors contributing to adverse kidney events during the outbreak.

Main Methods:

  • A before-and-after observational study design was employed, comparing a 13-month period before (Period A) and after (Period B) IR-AB outbreak control.
  • 409 patients were analyzed, with primary endpoint being major adverse kidney events at day 90 (MAKE 90), and secondary endpoints including acute kidney injury (AKI) and persistent renal dysfunction.

Main Results:

  • The incidence of MAKE 90 was 15.9% in Period A versus 11.2% in Period B (P=.166).
  • AKI incidence decreased from 28.2% to 18.7% (P=.023) after outbreak control.
  • Colistin use was significantly associated with an increased risk of MAKE 90 (RR=2.909, P=.006) and AKI (RR=2.14, P<.0001) after multivariable adjustment.

Conclusions:

  • The IR-AB outbreak was associated with an elevated risk of kidney injury.
  • Colistin emerged as a key factor driving the increased risk of adverse renal outcomes during the outbreak.
Keywords:
Intensive careMultidrug-resistant bacteriaNephrotoxicOutcomeRenal failure

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