Department of Critical Care, King Fahad Hospital, Al Madinah Al Monawarah, Saudi Arabia.
Department of Anaesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia.
J Crit Care. 2021 Dec;66:109-116. doi: 10.1016/j.jcrc.2021.08.010. Epub 2021 Sep 9.
Acinetobacter is an increasingly-problematic organism, especially in intensive care units (ICUs). In this study, we compared its incidence, outcomes, and predictors spanning eight ICUs in five geographically and climatologically-diverse cities in Saudi Arabia.
Geographic, climatologic, hospital-related, and patient-related factors were collected prospectively on 3179 patients admitted to eight Saudi ICUs from June 2018 through June 2019. These data then underwent both bivariable and multivariable analysis, the latter vis hierarchical logistic regression to identify predictors of clinically-manifest Acinetobacter infection.
Overall incidence of Acinetobacter infection was 3.9% (n = 124). Of these 124 infections, 122 (98.4%) were cultured as A. baumannii. Incidence ranged from 1.0 to 7.9% across the eight ICUs. On bivariable analysis, incident Acinetobacter infection was more common in university and military hospitals, in hospitals with more total beds and ICU isolation rooms, and in 2018 versus 2019, incidence steadily declining over the 13 study months. Mechanically-ventilated patients had ten-fold increased odds of infection. Adjusted (multivariable) analysis revealed the risk of clinically-manifest Acinetobacter infection to increase the longer patients were on mechanical ventilation. Increased risk also existed at certain hospitals over others, especially in university-affiliated and military hospitals, larger hospitals with more isolation rooms, and hospitals with fewer ICU beds.
In our study of eight ICUs across Saudi Arabia, inter-hospital differences did appear to account for inter-hospital differences in Acinetobacter incidence rates. Patients requiring mechanical ventilation for longer periods of time were particularly at risk.
不动杆菌属是一种日益严重的问题细菌，尤其是在重症监护病房（ICU）中。在这项研究中，我们比较了 8 家 ICU 横跨沙特阿拉伯五个地理位置和气候多样化城市的发病率、结局和预测因素。
在 2018 年 6 月至 2019 年 6 月期间，我们前瞻性地收集了 3179 名入住沙特阿拉伯 8 家 ICU 的患者的地理、气候、医院相关和患者相关因素。然后，我们对这些数据进行了单变量和多变量分析，后者采用分层逻辑回归来确定临床上表现出的不动杆菌感染的预测因素。
不动杆菌感染的总发病率为 3.9%（n=124）。在这 124 例感染中，122 例（98.4%）为鲍曼不动杆菌。8 家 ICU 的发病率从 1.0%到 7.9%不等。在单变量分析中，大学和军队医院、床位和 ICU 隔离室较多的医院、2018 年与 2019 年相比，不动杆菌感染的发生率更高，在 13 个月的研究期间，感染率稳步下降。机械通气患者感染的几率增加了 10 倍。调整后的（多变量）分析显示，患者接受机械通气的时间越长，发生临床明显不动杆菌感染的风险就越高。在某些医院，这种风险比其他医院更高，尤其是在大学附属和军队医院、床位和隔离室较多的大医院，以及 ICU 床位较少的医院。
在我们对沙特阿拉伯 8 家 ICU 的研究中，医院之间的差异似乎确实导致了不动杆菌感染率的医院间差异。需要长时间机械通气的患者风险特别高。
