Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Hospital Infection Control Committee, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Med Microbiol. 2020 Jan-Mar;38(1):24-31. doi: 10.4103/ijmm.IJMM_19_492.
Acinetobacter baumannii has become a common pathogen causing hospital-acquired infections (HAIs). Although acquiring any nosocomial infection is associated with increased mortality, we do not know if the acquisition of Acinetobacter infection confers a worse prognosis as compared to non-Acinetobacter-related HAI. The aim of the current study is to compare the clinical outcomes of ventilator-associated pneumonia (VAP) and central line associated blood stream infections (CLABSIs) caused by A. baumannii with those caused by other bacterial pathogens.
This prospective cohort study was conducted among critically ill adults admitted to a tertiary care hospital in South India from January 2013 to June 2014. We enrolled patients who developed new-onset fever ≥48 h after admission and fulfilled pre-specified criteria for VAP or CLABSI. The patients were followed up until the primary outcomes of death or hospital discharge.
During the study period, 4047 patients were admitted in the intensive care units, among which 129 eligible HAI events were analysed. Of these, 95 (73.6%) were VAP, 34 (26.4%) were CLABSI, 78 (60.4%) were A. baumannii-related HAI (AR-HAI) and 51 (39.6%) were non-A. baumannii-related HAI (NAR-HAI). Mortality among AR-HAI was 57.6% compared to 39.2% in NAR-HAI (P = 0.04) which on multivariate analysis did not achieve statistical significance, although the trend persisted (odds ratio [OR] = 4.2, 95% confidence interval [CI]: 0.95-18.4, P = 0.06). The acquisition of VAP due to A. baumannii was associated with poor ventilator outcomes even after adjusting for confounders (adjusted OR = 3.5, 95% CI: 1.07-11.6, P = 0.04).
In our cohort of critically ill adults with VAP and CLABSI, AR-HAI was associated with poor ventilator outcomes and a trend towards higher mortality. These findings add to the evidence suggesting that A. baumannii is a dangerous pathogen, perhaps even more so than others.
鲍曼不动杆菌已成为引起医院获得性感染（HAI）的常见病原体。虽然任何医院获得性感染的发生都与死亡率增加有关，但我们尚不清楚与非鲍曼不动杆菌相关的 HAI 相比，获得不动杆菌感染是否会带来更差的预后。本研究的目的是比较由鲍曼不动杆菌引起的呼吸机相关性肺炎（VAP）和中心静脉导管相关血流感染（CLABSI）与由其他细菌病原体引起的这些感染的临床结局。
这是一项前瞻性队列研究，于 2013 年 1 月至 2014 年 6 月在印度南部的一家三级护理医院对危重症成人进行。我们招募了在入院后 48 小时以上出现新发发热且符合 VAP 或 CLABSI 预定义标准的患者。对这些患者进行了随访，直至主要结局为死亡或出院。
在研究期间，有 4047 名患者入住重症监护病房，其中分析了 129 例符合条件的 HAI 事件。其中，95 例（73.6%）为 VAP，34 例（26.4%）为 CLABSI，78 例（60.4%）为鲍曼不动杆菌相关 HAI（AR-HAI），51 例（39.6%）为非鲍曼不动杆菌相关 HAI（NAR-HAI）。AR-HAI 的死亡率为 57.6%，而 NAR-HAI 为 39.2%（P=0.04），虽然趋势仍然存在，但多变量分析并未达到统计学意义（比值比[OR]为 4.2，95%置信区间[CI]为 0.95-18.4，P=0.06）。即使在调整混杂因素后，由鲍曼不动杆菌引起的 VAP 与呼吸机不良结局相关（调整 OR=3.5，95%CI：1.07-11.6，P=0.04）。
在我们的危重症成人 VAP 和 CLABSI 队列中，AR-HAI 与呼吸机不良结局相关，并存在死亡率更高的趋势。这些发现增加了证据表明，鲍曼不动杆菌是一种危险的病原体，甚至比其他病原体更危险。
