Risk factors for bacteremic pneumonia and mortality (28-day mortality) in patients with Acinetobacter baumannii bacteremia.

BACKGROUND: Patients infected with Acinetobacter baumannii (AB) bacteremia in hospital have high morbidity and mortality. We analyzed the clinical characteristics of pneumonia and nonpneumonia-related AB bloodstream infections (AB BSIs) and explored the possible independent risk factors for the incidence and prognosis of pneumonia-related AB BSIs. METHODS: A retrospective monocentric observational study was performed. All 117 episodes of hospital-acquired AB bacteremia sorted into groups of pneumonia-related AB BSIs (n = 45) and nonpneumonia-related AB BSIs (n = 72) were eligible. Univariate/multivariate logistic regression analysis was used to explore the independent risk factors. The primary outcome was the antibiotic susceptibility in vitro of pneumonia-related AB BSIs group. The secondary outcome was the independent risk factor for the pneumonia-related AB BSIs group. RESULTS: Among 117 patients with AB BSIs, the pneumonia-related group had a greater risk of multidrug resistant A. baumannii (MDRAB) infection (84.44%) and carbapenem-resistant A. baumannii (CRAB) infection (80%). Polymyxin, minocycline and amikacin had relatively high susceptibility rates (> 80%) in the nonpneumonia-related group. However, in the pneumonia-related group, only polymyxin had a drug susceptibility rate of over 80%. Univariate analysis showed that survival time (day), CRAB, MDRAB, length of hospital stay prior to culture, length of ICU stay prior to culture, immunocompromised status, antibiotics used prior to culture (n > = 3 types), endotracheal tube, fiberoptic bronchoscopy, PITT, SOFA and invasive interventions (n > = 3 types) were associated with pneumonia-related AB bacteremia. The multivariate logistic regression analysis revealed that recent surgery (within 1 mo) [P = 0.043; 0.306 (0.098-0.962)] and invasive interventions (n > = 3 types) [P = 0.021; 0.072 (0.008-0.671)] were independent risk factors related to pneumonia-related AB bacteremia. Multivariate logistic regression analysis revealed that length of ICU stay prior to culture [P = 0.009; 0.959 (0.930-0.990)] and recent surgery (within 1 mo) [P = 0.004; 0.260 (0.105-0.646)] were independent risk factors for mortality in patients with pneumonia-related AB bacteremia. The Kaplan‒Meier curve and the timing test showed that patients with pneumonia-related AB bacteremia had shorter survival time compared to those with nonpneumonia-related AB bacteremia. CONCLUSIONS: Our study found that A. baumannii had a high rate of antibiotic resistance in vitro in the pneumonia-related bacteremia group, and was only sensitive to polymyxin. Recent surgery was a significantly independent predictor in patients with pneumonia-related AB bacteremia.

The Value of Handgrip Strength and Self-Rated Squat Ability in Predicting Mild Cognitive Impairment: Development and Validation of a Prediction Model.

Early identification of individuals with mild cognitive impairment (MCI) is essential to combat worldwide dementia threats. Physical function indicators might be low-cost early markers for cognitive decline. To establish an early identification tool for MCI by combining physical function indicators (upper and lower limb function) via a clinical prediction modeling strategy. A total of 5393 participants aged 60 or older were included in the model. The variables selected for the model included sociodemographic characteristics, behavioral factors, mental status and chronic conditions, upper limb function (handgrip strength), and lower limb function (self-rated squat ability). Two models were developed to test the predictive value of handgrip strength (Model 1) or self-rated squat ability (Model 2) separately, and Model 3 was developed by combining handgrip strength and self-rated squat ability. The 3 models all yielded good discrimination performance (area under the curve values ranged from 0.719 to 0.732). The estimated net reclassification improvement values were 0.3279 and 0.1862 in Model 3 when comparing Model 3 to Model 1 and Model 2, respectively. The integrated discrimination improvement values were estimated as 0.0139 and 0.0128 when comparing Model 3 with Model 1 and Model 2, respectively. The model that contains both upper and lower limb function has better performance in predicting MCI. The final prediction model is expected to assist health workers in early identification of MCI, thus supporting early interventions to reduce future risk of AD, particularly in socioeconomically deprived communities.