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Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis
O Lortholary1, J Y Fagon, A B Hoi
1Service de Médecine Interne, Université Paris Nord, Bobigny, France.
Abstract:
To identify risk factors for and prognostic indicators of the nosocomial acquisition of multiresistant Acinetobacter baumannii in an intensive care unit, we prospectively studied 40 patients: 13 who were infected with this organism and 27 who were colonized. Isolates were identified by pulsed-field gel electrophoresis; the infected/colonized patients were compared with 348 noninfected, noncolonized patients by logistic regression analysis and with matched historical controls in a cohort study. The severity of illness (evaluated by the APACHE II score; P < .05) and previous infection (P < .001) were retained as independent risk factors for acquiring A. baumannii. Logistic regression analysis selected a high APACHE II score (P < .01) and the acquisition of A. baumannii (P < .01) as factors independently associated with death. The acquisition of A. baumannii was associated not only with high mortality but also with a length of stay on the intensive care unit in excess of that due to the underlying disease alone; specifically, the attributable mortality was 25%, with a risk ratio for death of 2.0 (95% confidence interval, 1.11-3.62), and the duration of stay for infected/colonized patients was 10.3 days longer than that for controls (P < .001).
Insights
Multiresistant Acinetobacter baumannii acquisition in intensive care units is linked to illness severity and prior infections. This bacterial strain increases mortality risk and prolongs hospital stays.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Nosocomial infections pose a significant threat in intensive care units (ICUs).
- Multiresistant Acinetobacter baumannii is a challenging pathogen in healthcare settings.
- Identifying risk factors and prognostic indicators for A. baumannii is crucial for patient outcomes.
Purpose of the Study:
- To determine risk factors for acquiring multiresistant Acinetobacter baumannii in an ICU.
- To identify prognostic indicators associated with A. baumannii infection or colonization.
- To evaluate the impact of A. baumannii on mortality and length of ICU stay.
Main Methods:
- Prospective study of 40 patients (13 infected, 27 colonized) with A. baumannii.
- Pulsed-field gel electrophoresis for isolate identification.
- Comparison with 348 non-infected/non-colonized patients and historical controls using logistic regression and cohort analysis.
Main Results:
- Severity of illness (APACHE II score) and previous infection were independent risk factors for A. baumannii acquisition.
- High APACHE II score and A. baumannii acquisition were independently associated with increased mortality.
- A. baumannii acquisition led to a 25% attributable mortality and increased ICU stay by 10.3 days.
Conclusions:
- Illness severity and prior infections are key risk factors for A. baumannii acquisition in ICUs.
- Acinetobacter baumannii significantly increases mortality risk and length of stay in critically ill patients.
- Effective infection control strategies are vital to mitigate the impact of A. baumannii in ICUs.