Department Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Eur J Intern Med. 2009 Sep;20(5):540-4. doi: 10.1016/j.ejim.2009.05.005. Epub 2009 May 29.
The incidence of multi-drug-resistant (MDR) Acinetobacter strains is increasing and therapeutic options are limited. However, controversy exists regarding the mortality attributable to antimicrobial resistance. The aim of this study was to analyse the clinical features and outcomes of patients with MDR Acinetobacter calcoaceticus-Acinetobacter baumannii complex (Acb complex) bacteraemia and determine the factors influencing survival by using 14-day mortality as the main outcome measure.
An observational study was conducted at a tertiary care hospital in Turkey from February 2007 to March 2008. Only one bacteraemic episode from one patient was included in the study.
A total of 100 clinically significant Acb complex bacteraemic episodes were detected. The overall mortality was 63% in 14 days. According to univariate analysis, diabetes mellitus, haematological malignancy, unknown source of bacteraemia, septic shock, resistance to carbapenems, and inappropriate empirical therapy were associated with mortality amongst patients with Acb complex bacteraemia. Multivariate analysis showed that diabetes mellitus (RR, 1.68; 95% CI, 1.22-1.76), carbapenem resistance (RR, 1.63; 95% CI, 1.19-1.89), and septic shock (RR, 1.65; 95% CI, 1.23-1.85) were independent risk factors for 14-day mortality.
Although severe underlying diseases play an important role in the clinical outcome of patients with Acb complex bacteraemia, carbapenem resistance and inappropriate therapy are of great concern. Special attention should be paid to infection control practices in the hospitals where MDR Acinetobacter infections are endemic, and well-controlled prospective clinical trials are needed to determine the optimal antimicrobial therapy in critically ill patients suspected of having MDR Acinetobacter bacteraemia.
耐多药（MDR）不动杆菌菌株的发病率正在上升，治疗选择有限。然而，关于抗微生物药物耐药性导致的死亡率仍存在争议。本研究旨在分析多重耐药鲍曼不动杆菌-醋酸钙不动杆菌复合菌（Acb 复合菌）菌血症患者的临床特征和结局，并通过以 14 天死亡率作为主要结局指标来确定影响生存的因素。
本研究为 2007 年 2 月至 2008 年 3 月在土耳其一家三级保健医院进行的观察性研究。仅纳入每位患者的一次菌血症发作。
共检测到 100 例有临床意义的 Acb 复合菌菌血症发作。14 天内的总体死亡率为 63%。根据单因素分析，糖尿病、血液系统恶性肿瘤、菌血症来源不明、感染性休克、对碳青霉烯类药物的耐药性以及不适当的经验性治疗与 Acb 复合菌菌血症患者的死亡率相关。多因素分析显示，糖尿病（RR，1.68；95%CI，1.22-1.76）、碳青霉烯类耐药（RR，1.63；95%CI，1.19-1.89）和感染性休克（RR，1.65；95%CI，1.23-1.85）是 14 天死亡率的独立危险因素。
尽管严重的基础疾病对 Acb 复合菌菌血症患者的临床结局有重要影响，但碳青霉烯类耐药和不适当的治疗值得高度关注。在不动杆菌感染流行的医院，应特别注意感染控制措施，并且需要进行良好对照的前瞻性临床试验，以确定怀疑患有多重耐药不动杆菌菌血症的危重症患者的最佳抗菌治疗方案。
