Predictors of mortality of Acinetobacter baumannii infections: A 2-year prospective study in a Greek surgical intensive care unit.

ABSTRACT

BACKGROUND: Nosocomial infections are a frequent and continuously increasing problem worldwide, have a rapidly increasing multidrug resistance to antibiotics, and are associated with significant morbidity and mortality. OBJECTIVE: Our objectives were to evaluate Acinetobacter baumannii infection incidence in our surgical intensive care unit (SICU), the clinical features and outcome of these patients, and, particularly, to investigate predictors of A baumannii infection-related mortality. METHODS: Ours was a prospective study of all patients with ICU-acquired A baumannii infection from January 1, 2006, to December 31, 2007. RESULTS: Among 680 patients, 60 (8.8%) sustained A baumannii infection. Mean age was 68.4 ± 6.2 years, Acute Physiology and Chronic Health Evaluation (APACHE) II score on SICU admission 20.6 ± 8.1 and Sequential Organ Failure Assessment (SOFA) score on infection day 9.5 ± 4.2 (women 50%). Multidrug resistance, morbidity, and mortality were 45%, 65%, and 46.6% (n = 28), respectively. In multivariate analysis, age (P = .03; odds ratio [OR], 1.13; 95% confidence interval [CI] 1.018-1.259), acute renal failure (P = .001; OR, 17.9; 95% CI 6.628-75.565), and thrombocytopenia (P = .03; OR, 26.4; 95% CI 1.234-56.926) complicating the infection and subsequent Enterococcus faecium bacteremia (P = .01; OR, 3.5; 95% CI 1.84-6.95) were mortality predictors. CONCLUSION: A baumannii infections are frequent and associated with high drug multiresistance, morbidity, and mortality. Age, renal failure, thrombocytopenia, and subsequent E faecium bacteremia were predictors of A baumannii infection-associated mortality.