Impact of an Acinetobacter baumannii outbreak on kidney events in a burn unit: A targeted machine learning analysis.
Am J Infect Control
; 47(4): 435-438, 2019 04.
Article
em En
| MEDLINE
| ID: mdl-30503627
ABSTRACT
BACKGROUND:
Multidrug-resistant (MDR) bacteria outbreaks represent a major threat in intensive care units. Patients may then be exposed to drug-related direct toxicity during such outbreaks. The objective of this study was to explore the impact of an outbreak of imipenem-resistant Acinetobacter baumannii (IR-AB) on renal outcomes.METHODS:
We performed a before-and-after observational study in a French burn intensive care unit during an IR-AB outbreak a 13-month period before (period A, October 2013-October 2014) and a 13-month period after outbreak control (period B, December 2014-December 2015). A total of 409 patients were included, 195 during period A and 214 during period B. The main endpoint was major adverse kidney events at day 90 (MAKE 90). Secondary endpoints were acute kidney injury (AKI) and persistent renal dysfunction.RESULTS:
Incidence of MAKE 90 was 15.9% during period A versus 11.2% during period B (Pâ¯=â¯.166) and AKI 28.2% versus 18.7% (Pâ¯=â¯.023). The use of colistin was associated with renal outcomes in univariate analysis. After adjustment of potential confounding factors using a targeted Machine Learning Analysis (ie, IR-AB-related infection, septic shock, severity scores, other nephrotoxics, chronic kidney disease, serum creatinine at admission, Staphylococcus aureus), colistin remained associated with the risk of MAKE and AKI (relative riskâ¯=â¯2.909, 95% confidence interval [CI] [1.364, 6.204], Pâ¯=â¯.006 for MAKE 90, and relative riskâ¯=â¯2.14, 95% CI [1.52, 3.02], P<.0001 for AKI).CONCLUSIONS:
The episode of IR-AB outbreak was associated with an increased risk of kidney events, which appears to be driven by the use of colistin.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Queimaduras
/
Infecções por Acinetobacter
/
Surtos de Doenças
/
Resistência beta-Lactâmica
/
Acinetobacter baumannii
/
Injúria Renal Aguda
/
Antibacterianos
Tipo de estudo:
Observational_studies
/
Systematic_reviews
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
Am J Infect Control
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
França