ABSTRACT
BACKGROUND: Pandrug-resistant Acinetobacter baumannii (PDRAB) is increasingly being reported as a nosocomial pathogen worldwide, but determining its clinical impact is challenging. AIM: To assess the spectrum of excess mortality attributable to PDRAB infection in acute care settings. METHODS: This four-year cohort study was conducted in a tertiary-care referral hospital in Greece to estimate excess in-hospital mortality due to PDRAB infection by comparing patients infected to those colonized with PDRAB by means of competing risks survival analysis. FINDINGS: The study cohort comprised 91 patients (median age: 67 years; 77% men). For most patients, PDRAB was first isolated in the intensive care unit (ICU) (N = 51; 57%) or following ICU discharge (N = 26; 29%). Overall in-hospital mortality was 68% (95% confidence interval (CI): 57.5-77.5%). PDRAB-infected patients (N = 62; 68%) and PDRAB-colonized patients (N = 29; 32%) had similar baseline characteristics, but the absolute excess risk of 30-day mortality in infected patients compared to colonized patients was 34% (95% CI: 14-54%). Multivariable competing risks regression showed that PDRAB infection significantly increased the daily hazard of 30-day in-hospital death (cause-specific hazard ratio (csHR): 3.10; 95% CI: 1.33-7.21) while simultaneously decreasing the daily rate of discharge (csHR: 0.24; 95% CI: 0.08-0.74), thereby leading to longer hospitalization. Stronger effects were observed for bloodstream infections. CONCLUSION: New effective antimicrobials would be expected to prevent mortality in one of every three patients treated for PDRAB infection and reduce their length of hospitalization. However, available therapeutic options remain extremely limited and emphasis on preventing healthcare-associated transmission of PDRAB is ever more important.
Subject(s)
Acinetobacter Infections/mortality , Anti-Bacterial Agents/pharmacology , Cross Infection/mortality , Drug Resistance, Multiple, Bacterial , Acinetobacter Infections/drug therapy , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/pathogenicity , Aged , Anti-Bacterial Agents/therapeutic use , Cohort Studies , Cross Infection/microbiology , Cross Infection/prevention & control , Female , Greece , Hospital Mortality , Hospitalization , Humans , Intensive Care Units/statistics & numerical data , Male , Microbial Sensitivity Tests , Middle AgedABSTRACT
OBJECTIVES: Vaccination coverage of general practitioners (GPs) is important for their own and for their colleagues' and patients' protection and has been associated with the coverage of the general population. Our study aims to evaluate the vaccination practices of GPs in Crete, Greece. STUDY DESIGN: Cross-sectional, questionnaire-based survey. METHODS: All practicing GPs in Crete (n = 294) were surveyed either by questionnaires or by phone call. We assessed the vaccination coverage and practices for influenza, measles, hepatitis B, and pertussis (booster Tdap dose) and the reasons for nonvaccination for influenza. RESULTS: A total of 260 (88% response rate) GPs participated. Vaccination rates were 56% for influenza (current season), 26% for measles (two doses), 68% for hepatitis B (three doses), and 18% for the booster dose with Tdap. Negligence (47%) and perceived low risk (29.6%) were the most common reasons for nonvaccination for influenza. History of natural measles infection was reported by 169 (65%) GPs, but none of the interviewed 31 provided laboratory confirmation. GPs with self-reported natural measles infection were less vaccinated than their peers (10% vs 55%, P < 0.001). Finally, 23 of 130 (18%) GPs contacted by phone falsely reported vaccination with Tdap in their childhood, when Tdap was not yet available. CONCLUSION: This study revealed insufficient vaccination rates and misconceptions among GPs that should be the focus of future evidence-based interventions with potential to significantly improve vaccination coverage of GPs and indirectly of their patients.
