Analysis of clinical manifestations and risk factors of mortality in Acinetobacter baumannii bloodstream infection / 中华内科杂志

ABSTRACT

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.