Increased incidence of resistant Acinetobacter baumannii accounts for significant mortality in hospitalized patients. We sought to determine the outcome of infected vs. colonized patients.
Clinical data and outcome variables were extracted from medical records of 120 adult patients with culture(s) positive for Acinetobacter baumannii admitted to Kings County Hospital from January 2006 until November 2008. A total of 163 Acinetobacter isolates were recorded from 120 patients. Blood and/or cultures treated as an active infection were given more significance. Each patient's data was entered only once. A p value of < 0.05 was considered statistically significant.
60 patients were admitted to MICU, 46 to SICU and the rest to medical floors. 46 (39%) patients had a previous hospitalization within 30 days. Co-morbid conditions such as diabetes (42%), previous steroid use (47%), renal failure (43%), HIV (23%) and malignancy (12%) were frequent. Most patients required mechanical ventilation and vasopressor support (Table).Common admitting diagnoses were sepsis (29%), neurological disorder (23%) and trauma (17%). Commonly isolated from sputum (90 isolates), blood (29), urine (24), catheter tip (13) and others (7)Mortality was 24% (7/29) in patients with bacteremia, 34% (22/64) in patients with positive sputum culture and 16% (4/24) in patients with positive urine culture. Mortality was not significantly different if treating physician considered the sputum isolate to be a true infection or a colonizer (44% vs. 25%; p = 0.11). Overall, mortality was associated with a higher steroid use and evidence of multiorgan failure on the day of culture. Appropriate antibiotic therapy resulted in decreased mortality in patient with bacteremia (32 vs 0%: p = 0.002), but not in 24 out of 56 patients with lower respiratory infection with positive sputum cultures.
The site of infection and its appropriate therapy, determine outcome in Acinetobacter infection. Isolating and treating sputum Acinetobater isolates may not necessarily change MICU outcome.
In critically ill patient at high risk for hospital acquired bacteremia, initial antibiotic therapy should be expanded to cover Acinetobacter based on local sensitivity.
Ikenna Onyebueke, No Financial Disclosure Information; No Product/Research Disclosure Information