Seifert H, Strate A, Pulverer G
Institute of Medical Microbiology and Hygiene, University of Cologne, Germany.
Medicine (Baltimore). 1995 Nov;74(6):340-9. doi: 10.1097/00005792-199511000-00004.
To study the possible predisposing factors, clinical features, molecular epidemiology, and factors affecting mortality associated with bacteremia due to Acinetobacter baumannii, we reviewed 87 episodes of A. baumannii bacteremia occurring in 79 patients hospitalized at 2 university tertiary care centers and 4 community-based hospitals during a recent 18-month period. Plasmid DNA analysis and analysis of genomic DNA with pulsed-field gel electrophoresis was performed to investigate possible epidemiologic relationship. All patients acquired their infections in the hospital, and no seasonal variation was observed. Among patients with A. baumannii bacteremia, 91% were hospitalized in an intensive care unit, 99% had indwelling vascular catheters, 81% received prior broad spectrum antimicrobial therapy, 70% were mechanically ventilated, and 47% had major surgical procedures. In 39 cases (45%) the infection was related to indwelling vascular access devices. Other infections included pneumonia (9%), tracheobronchitis (22%), meningitis (2%), and burn wound infections (4%). Septic shock occurred in 30% of patients. All isolates were multidrug resistant. Polymicrobial bacteremia was observed in 35% of cases. The crude mortality rate was 44%. Death was considered attributable to A. baumannii bacteremia in 15 (19%) patients. All patients with pneumonia as the primary site of infection died. Using multivariate analysis, we identified 3 independent predictors of mortality: the presence of a rapidly or ultimately fatal underlying disease (p = 0.0009), septic shock at the onset of bacteremia (p = 0.0013), and mechanical ventilation (p = 0.016). Epidemiologic typing revealed that 82 episodes were associated with different hospital outbreaks of infection, and only 7 episodes were due to epidemiologically unrelated strains.
为研究鲍曼不动杆菌所致菌血症的潜在易感因素、临床特征、分子流行病学及影响死亡率的因素，我们回顾了79例患者发生的87次鲍曼不动杆菌菌血症发作情况，这些患者在最近18个月期间于2所大学三级护理中心和4所社区医院住院。采用质粒DNA分析及脉冲场凝胶电泳分析基因组DNA，以研究可能的流行病学关系。所有患者均在医院获得感染，未观察到季节性变化。在鲍曼不动杆菌菌血症患者中，91%在重症监护病房住院，99%有留置血管导管，81%接受过先前的广谱抗菌治疗，70%接受机械通气，47%接受过大手术。39例（45%）感染与留置血管通路装置有关。其他感染包括肺炎（9%）、气管支气管炎（22%）、脑膜炎（2%）和烧伤创面感染（4%）。30%的患者发生感染性休克。所有分离株均对多种药物耐药。35%的病例观察到多微生物菌血症。粗死亡率为44%。15例（19%）患者的死亡被认为归因于鲍曼不动杆菌菌血症。所有以肺炎为主要感染部位的患者均死亡。通过多变量分析，我们确定了3个死亡率的独立预测因素：存在快速或最终致命的基础疾病（p = 0.0009）、菌血症发作时的感染性休克（p = 0.0013）和机械通气（p = 0.016）。流行病学分型显示，82次发作与不同医院的感染暴发有关，只有7次发作是由流行病学无关的菌株引起的。
