PURPOSE:Acinetobacter has emerged as a potential threat to the patients admitted in the ICU. However factors predisposing to it and the consequences therein vary across different settings and have not been addressed in ICU of developing countries.
METHODS:Retrospective analysis of the data from the consecutively admitted patients to a multidisciplinary ICU of a teaching hospital over a period of six months was done. In all clinically suspected patients, the first blood stream sample sent for culture was considered. Patients with A. baumanni BSI were compared to the patients with non-Acinetobacter gram negative rods BSI.
RESULTS:120(20.5%) samples from the total of 584, isolated gram negative rods. Of these 120, 48(40%) isolated A. baumanni while 72(60%) isolated other gram negative rods. 58%(28/48) patients with A. baumanni BSI were males. Mean age in years was significantly higher in patients with A. baumanni BSI as compared to those with other gram negative rods BSI (67±50vs43±32,P=0.00). Patients with A. baumanni BSI had significantly more days of ICU stay (27.7±26.2vs16.8±14.9,P=0.01), more patients had prior hospitalization (29/48vs20/72,P=0.02) and mortality too was significantly higher (20/48vs13/72,P=0.03) as compared to those with other gram negative rods BSI. The mean SAPS II (simplified acute physiology score) predicted death rate was significantly higher in patients with A. baumanni BSI as compared with those having other gram negative rods BSI(76%vs53%,95%CI=6.3–39.7,P=0.02). BSI with the A. baumanni was an independent risk factor for mechanical ventilation (32/48vs25/72, OR=1.9, 95% CI=1.0–3.6, P=0.04). The odds of having A. baumanni BSI was significantly higher in diabetics (25/48vs17/72,OR=2.2,95%CI=1.07–4.51,P=0.02), patients with solid malignancy (15/48vs8/72,OR=2.8,95%CI=1.1–7.1,P=0.02), pneumonia (12/48vs5/72, OR=3.6,95%CI=1.2–10.8,P=0.01) and with renal failure (32/48vs24/72, OR=2.0, 95%CI=1.0–3.8, P=0.03).
CONCLUSION:Acinetobacter is an independent risk factor for the morbidity and mortality in ICU. Elderly patients, previously hospitalized, diabetics, patients with solid malignancy, pneumonia and renal failure were more susceptible to A. baumanni infection.
CLINICAL IMPLICATIONS:BSI with A baumannii is responsible for a poor outcome as compared to other gram negative rods in patients admitted in ICU.
DISCLOSURE:Dr. Sandeep Sahay, No Financial Disclosure Information; No Product/Research Disclosure Information