Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Antimicrob Agents Chemother. 2022 Mar 15;66(3):e0197521. doi: 10.1128/AAC.01975-21. Epub 2022 Jan 10.
The objectives were to analyze treatment, clinical outcomes, and predictors of mortality in hospitalized patients with Acinetobacter baumannii infection. This was a retrospective cohort study of inpatients with A. baumannii cultures and treatment from 2010 to 2019. Patients who died during admission were compared to those who survived, to identify predictors of inpatient mortality, using multivariable unconditional logistic regression models. We identified 4,599 inpatients with A. baumannii infection; 13.6% died during admission. Fluoroquinolones (26.8%), piperacillin-tazobactam (24%), and carbapenems (15.6%) were used for treatment. Tigecycline (3%) and polymyxins (3.7%) were not used often. Predictors of inpatient mortality included current acute respiratory failure (adjusted odds ratio [aOR] 3.94), shock (aOR 3.05), and acute renal failure (aOR 2.01); blood (aOR 1.94) and respiratory (aOR 1.64) infectious source; multidrug-resistant A. baumannii (MDRAB) infection (aOR 1.66); liver disease (aOR 2.15); and inadequate initial treatment (aOR 1.30). Inpatient mortality was higher in those with MDRAB versus non-MDRAB (aOR 1.61) and in those with CRAB versus non-CRAB infection (aOR 1.68). Length of stay >10 days was higher among those with MDRAB versus non-MDRAB (aOR 1.25) and in those with CRAB versus non-CRAB infection (aOR 1.31). In our national cohort of inpatients with A. baumannii infection, clinical outcomes were worse among those with MDRAB and/or CRAB infection. Predictors of inpatient mortality included several current conditions associated with severity, infectious source, underlying illness, and inappropriate treatment. Our study may assist health care providers in the early identification of admitted patients with A. baumannii infection who are at higher risk of death.
目的在于分析住院患者感染鲍曼不动杆菌的治疗方法、临床结局和死亡率预测因素。这是一项回顾性队列研究，纳入了 2010 年至 2019 年间住院患者的鲍曼不动杆菌培养物和治疗数据。比较住院期间死亡的患者与存活的患者，以确定住院患者死亡率的预测因素，采用多变量非条件逻辑回归模型。我们共纳入了 4599 例鲍曼不动杆菌感染住院患者；13.6%的患者在住院期间死亡。氟喹诺酮类（26.8%）、哌拉西林他唑巴坦（24%）和碳青霉烯类（15.6%）被用于治疗。替加环素（3%）和多黏菌素（3.7%）的使用率较低。住院患者死亡率的预测因素包括：当前急性呼吸衰竭（调整后的优势比[aOR]3.94）、休克（aOR 3.05）和急性肾衰竭（aOR 2.01）；血液（aOR 1.94）和呼吸道（aOR 1.64）感染源；多重耐药鲍曼不动杆菌（MDRAB）感染（aOR 1.66）；肝脏疾病（aOR 2.15）；以及初始治疗不充分（aOR 1.30）。与非 MDRAB 感染相比，MDRAB 感染患者（aOR 1.61）和碳青霉烯耐药鲍曼不动杆菌（CRAB）感染患者（aOR 1.68）的住院患者死亡率更高。与非 MDRAB 感染相比，MDRAB 感染患者（aOR 1.25）和 CRAB 感染患者（aOR 1.31）的住院时间>10 天的比例更高。在我们的国家住院患者鲍曼不动杆菌感染队列中，MDRAB 和/或 CRAB 感染患者的临床结局更差。住院患者死亡率的预测因素包括几个与严重程度、感染源、基础疾病和不适当治疗相关的当前状况。我们的研究可能有助于医疗保健提供者早期识别具有更高死亡风险的住院患者。
