Risk Factors for Developing Infection Among Patients with Previous Carbapenem-Resistant Acinetobacter baumannii in...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Hospital Epidemiology

Background:

• Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant threat as an opportunistic pathogen, leading to colonization and nosocomial infections.
• Understanding the transition from CRAB colonization to active infection is crucial for effective patient management and infection control.

Purpose of the Study:

• To identify independent risk factors associated with the progression from respiratory colonization to infection in patients colonized with CRAB in general hospital wards.
• To analyze factors contributing to 28-day mortality among CRAB-infected patients who initially presented with colonization.

Main Methods:

• A retrospective study was conducted involving 202 patients colonized with CRAB in general wards from January 2021 to December 2023.
• Univariate and multivariable logistic regression models were utilized to determine factors associated with the progression from colonization to infection and subsequent mortality.

Main Results:

• Of 202 CRAB-colonized patients, 66 progressed to infection, and 36 experienced 28-day mortality. Patients with subsequent infection had a higher mortality rate (27.27% vs. 13.24%).
• Independent risk factors for progression to infection included lower albumin (ALB) levels (OR=0.94), antibiotic use (OR=2.49), and glucocorticoid use (OR=2.49).
• For patients who developed CRAB infection after colonization, antifungal drug use (OR=18.06) and central venous catheter presence (OR=10.73) were significantly associated with 28-day mortality.

Conclusions:

• Lower ALB levels and the use of antibiotics or glucocorticoids are identified as key risk factors for CRAB infection development in colonized patients within general medicine wards.
• Among CRAB-infected patients, the use of antifungal agents and the presence of central venous catheters are critical factors associated with increased 28-day mortality.
• These findings underscore the need for targeted preventive strategies and optimized therapeutic guidelines to mitigate the impact of CRAB infections in hospitalized patients.