Risk factors for mortality in Acinetobacter baumannii bloodstream infections and development of a predictive
Silvia Corcione1, Bianca Maria Longo2, Silvia Scabini2
1Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Italy; School of Medicine, Tufts University, Boston, Massachusetts, USA.
Objectives:
Acinetobacter baumannii (A. baumannii) nosocomial infections represent a serious hazard to public health, given high mortality rates and rapid spread of multidrug-resistance. The primary outcome of this study was to evaluate predictors of 14- and 30-d mortality in bloodstream infections (BSIs) due to both carbapenem-resistant and carbapenem-sensitive Acinetobacter. Secondary end points were to identify risk factors for BSIs due to carbapenem-resistant A. baumannii (CRAB) and to develop a predictive model for mortality in CRAB-related BSIs.
Methods:
Between 2019 and 2023, all consecutive hospitalized adult patients with bacteraemia due to A. baumannii were retrospectively enrolled at a single-centre.
Results:
One hundred twenty-six episodes of BSI caused by A. baumannii were recorded, 89.7% of which were due to CRAB. Recent burn injuries, older age, previous CRAB colonization, and antibiotics exposure were identified as risk factors for acquiring CRAB BSI. Overall, 14-d mortality was observed in 26.1% of the patients and 30-d mortality in 30.9% of the patients. On multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score was associated with both 14- and 30-d mortality, whereas burn injuries correlated with 30-d survival. Concurrent coronavirus disease (COVID) was associated with mortality, although not reaching statistical figures. No major impact of receiving appropriate treatment was observed. Based on these findings, a multivariable model to predict mortality among patients with CRAB BSI was built and internally validated.
Conclusions:
A. baumannii BSIs are characterized by poor outcomes and limited therapeutic options. This study aimed to assist physicians in prompt identification of patients who are at greater risk of death, contributing to more informed clinical decision making.
Insights
Acinetobacter baumannii bloodstream infections have high mortality. The Sequential Organ Failure Assessment (SOFA) score predicts mortality, while burn injuries impact survival in these critical infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Resistance
Background:
- Acinetobacter baumannii bloodstream infections (BSIs) pose a significant public health threat due to high mortality and multidrug resistance.
- Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are particularly challenging, with limited treatment options.
Purpose of the Study:
- To evaluate predictors of 14- and 30-day mortality in Acinetobacter baumannii BSIs.
- To identify risk factors for CRAB BSIs.
- To develop a predictive model for mortality in CRAB-related BSIs.
Main Methods:
- Retrospective analysis of 126 adult patients with A. baumannii bacteremia between 2019 and 2023.
- Multivariate analysis to identify mortality predictors and risk factors.
- Development and internal validation of a predictive model for CRAB BSI mortality.
Main Results:
- 89.7% of A. baumannii BSIs were CRAB.
- Risk factors for CRAB BSI included burn injuries, older age, prior CRAB colonization, and antibiotic exposure.
- 14-day mortality was 26.1%, and 30-day mortality was 30.9%.
- Sequential Organ Failure Assessment (SOFA) score predicted both 14- and 30-day mortality.
- Burn injuries correlated with 30-day survival; COVID-19 association with mortality was noted but not statistically significant.
Conclusions:
- A. baumannii BSIs are associated with poor outcomes and limited therapeutic choices.
- The SOFA score is a key predictor of mortality in these infections.
- A validated predictive model can aid clinicians in identifying high-risk patients for improved decision-making.
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