Choi J Y, Park Y S, Kim C O, Park Y S, Yoon H J, Shin S Y, Kim Y-A, Song Y G, Yong D, Lee K, Kim J M
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Intern Med J. 2005 Oct;35(10):599-603. doi: 10.1111/j.1445-5994.2005.00925.x.
Acinetobacter baumannii is one of the most important nosocomial pathogens, and its multiple antibiotic resistance has emerged as an obstacle in the treatment of these infections worldwide.
To identify risk factors of mortality for A. baumannii bacteraemia.
A retrospective cohort study of 72 patients with significant A. baumannii bacteraemia was conducted to evaluate risk factors for mortality.
The median age of the 72 enrolled patients was 48 years, 96% of the cases were hospital-acquired, and the bacteraemia-related mortality rate was 29% (21 of 72 patients). Univariate analysis revealed that the risk factors for mortality included: an elevated acute physiology and chronic health evaluation (APACHE II) score, receipt of in vitro ineffective definitive antimicrobial therapy, in vitro A. baumannii resistance to cefoperazone/ sulbactam, neutropenia, and presentation with septic shock. Multivariate analysis reveals that the independent risk factors for mortality are neutropenia and elevated APACHE II scores.
Risk factors such as neutropenia and elevated APACHE II scores are found to be associated with higher mortality rates of A. baumannii bacteraemia. Further study is necessary for the determination of optimal strategies for both the prevention and treatment of these infections.
鲍曼不动杆菌是最重要的医院病原体之一，其多重耐药性已成为全球治疗这些感染的障碍。
确定鲍曼不动杆菌菌血症患者死亡的危险因素。
对72例确诊为鲍曼不动杆菌菌血症的患者进行回顾性队列研究，以评估死亡的危险因素。
72例入选患者的中位年龄为48岁，96%的病例为医院获得性感染，菌血症相关死亡率为29%（72例患者中有21例）。单因素分析显示，死亡的危险因素包括：急性生理与慢性健康状况评分系统（APACHE II）评分升高、接受体外无效的确定性抗菌治疗、鲍曼不动杆菌对头孢哌酮/舒巴坦体外耐药、中性粒细胞减少以及出现感染性休克。多因素分析显示，死亡的独立危险因素是中性粒细胞减少和APACHE II评分升高。
发现中性粒细胞减少和APACHE II评分升高与鲍曼不动杆菌菌血症的较高死亡率相关。有必要进一步研究确定预防和治疗这些感染的最佳策略。
