Nosocomial bacteremia due to Acinetobacter baumannii. Clinical features, epidemiology, and predictors of mortality.

摘要: 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 occurring in 79 patients hospitalized at 2 university tertiary care centers 4 community-based hospitals during a recent 18-month period. Plasmid DNA analysis genomic pulsed-field gel electrophoresis was performed investigate epidemiologic relationship. All acquired their infections hospital, no seasonal variation observed. Among bacteremia, 91% were an intensive unit, 99% had indwelling vascular catheters, 81% received prior broad spectrum antimicrobial therapy, 70% mechanically ventilated, 47% major surgical procedures. In 39 cases (45%) infection related access devices. Other included pneumonia (9%), tracheobronchitis (22%), meningitis (2%), burn wound (4%). Septic shock occurred 30% patients. isolates multidrug resistant. Polymicrobial observed 35% cases. The crude rate 44%. Death considered attributable 15 (19%) as primary site died. Using multivariate analysis, identified 3 independent predictors mortality: presence rapidly or ultimately fatal underlying disease (p = 0.0009), septic onset 0.0013), mechanical ventilation 0.016). Epidemiologic typing revealed that 82 different hospital outbreaks infection, only 7 epidemiologically unrelated strains.