A Multicenter Case-Case Control Study for Risk Factors and Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Bacteremia
In: Infection control and hospital epidemiology, Jg. 35 (2014), Heft 1, S. 49-55
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Zugriff:
OBJECTIVE. Extensively drug resistant (XDR) Acinetobacter baumannii infections are increasing. Knowledge of risk factors can help to prevent these infections. METHODS. We designed a 1: 1: 1 case-case-control study to identify risk factors for XDR A. baumannii bacteremia in Singapore and Thailand. Case group 1 was defined as having infection due to XDR A. baumannii, and case group 2 was defined as having infection due to non-XDR A. baumannii. The control group comprised patients with blood cultures obtained to determine possible infection. RESULTS. There were 93 patients in each group. Pitt bacteremia score (adjusted odds ratio [aOR], 2.570 [95% confidence interval (CI), 1.528―4.322]), central venous catheters (CVCs; aOR, 12.644 [95% CI, 2.143―74.620]), use of carbapenems (aOR, 54.391 [95% CI, 3.869― 764.674]), and piperacillin-tazobactam (aOR, 55.035 [95% CI, 4.803―630.613]) were independently associated with XDR A. baumannii bacteremia. In case group 2, Pitt bacteremia score (aOR, 1.667 [95% CI, 1.265―2.196]) and third-generation cephalosporins (aOR, 2.965 [95% CI, 1.224―7.182]) were independently associated with non-XDR A. baumannii bacteremia. Concurrent infections (aOR, 3.527 [95% CI, 1.479―8.411]), cancer (aOR, 3.172 [95% CI, 1.135―8.865]), and respiratory source (aOR, 2.690 [95% CI, 1.160―6.239]) were associated with an increased risk of 30-day mortality. Survivors received more active empirical therapy (16.7% vs 9.6%; P = .157), had fewer cases of XDR bacteremia (45.8% vs 52.6%; P = .452), and received higher median definitive polymyxin B doses (840,000 units vs 700,000 units; P = .339) CONCLUSIONS. Use of CVC and broad spectrum antibiotics were unique risk factors of XDR A. baumannii bacteremia. Effective antimicrobial stewardship together with use of a CVC bundle may reduce the incidence of these infections. Risk factors of acquisition and mortality may help identify patients for early initiation of polymyxin B therapy.
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A Multicenter Case-Case Control Study for Risk Factors and Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Bacteremia
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Autor/in / Beteiligte Person: | TAT MING, NG ; TENG, Christine B ; LYE, David C ; APISARNTHANARAK, Anucha |
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Zeitschrift: | Infection control and hospital epidemiology, Jg. 35 (2014), Heft 1, S. 49-55 |
Veröffentlichung: | Chicago, IL: University of Chicago Press, 2014 |
Medientyp: | academicJournal |
Umfang: | print, 29 ref |
ISSN: | 0899-823X (print) |
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