Doctorado Interfacultades en Salud Publica, Universidad Nacional de Colombia, Bogota Cundinamarca, Colombia; Fundación para el desarrollo y apoyo en salud internacional, (FUDASAI), Bogota, Colombia.
Clin Microbiol Infect. 2014 Feb;20(2):174-80. doi: 10.1111/1469-0691.12251. Epub 2013 May 13.
Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14-3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74-2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.
鲍曼不动杆菌是引起医疗保健相关性感染的主要原因，常影响重症患者。本研究旨在探讨哥伦比亚重症监护病房（ICU）中感染鲍曼不动杆菌患者的碳青霉烯类耐药与死亡率、住院时间和住院费用的相关性。2006 年 4 月至 2010 年 4 月期间，对 ICU 中 165 例鲍曼不动杆菌感染患者进行了前瞻性、多中心队列研究。在单因素分析中，与碳青霉烯类敏感的鲍曼不动杆菌患者相比，碳青霉烯类耐药的鲍曼不动杆菌患者 30 天死亡率更高（未调整危险比[HR]为 2.12；95%CI 为 1.14-3.95；p = 0.018）。然而，在调整急性生理学与慢性健康状况评分系统（APACHE II）评分和其他混杂因素后，碳青霉烯类耐药与死亡率无显著相关性（调整 HR 为 1.45；95%CI 为 0.74-2.87；p = 0.28）。在多因素分析中，两组患者感染后 ICU 住院时间无显著差异（调整后平均住院时间分别为 13.1 天和 10.5 天；p = 0.14）。在多因素分析中，碳青霉烯类耐药的鲍曼不动杆菌患者的平均总住院费用明显高于碳青霉烯类敏感的鲍曼不动杆菌患者（调整费用分别为 11359 美元和 7049 美元；p <0.001）。尽管由于样本量有限，无法排除风险增加的可能性，但碳青霉烯类耐药与死亡率无显著相关性。碳青霉烯类耐药与住院费用增加有关。
