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Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients

Yıl 2013, , 157 - 162, 01.12.2013
https://doi.org/10.5799/ahinjs.02.2013.04.0101

Öz

Objective: This study was performed to identify risk factors and to determine the attributable mortality and clinical outcomes of nosocomial Acinetobacter bacteremia in our intensive care unit. Methods: A retrospective case-control (1:1) study was conducted in a tertiary, academic hospital composed of 300 beds. The control group consisted of 54 consecutive patients with negative blood cultures, matched by sex, age (&plusmn;10 years), primary and secondary diagnosis, operative procedures, and date of admission. Results: There was a trend for a longer median duration of hospitalization among the patient group compared with the control group (25.0 versus 8.0 days; p=0.001). Patients with Acinetobacter bacteremia had significantly more hemodynamic instability (hypoxia, shock) (p=0.001). We detected that the presence of risk factors such as mechanical ventilation, central venous catheter, anemia, thrombocytopenia, hypoalbuminemia and impairment in creatinine clearance was higher in the patient group than in the control group (p<0.004). Thirty-three (61.1%) of the cases died whereas 14 (25.9%) of the controls died (p=0.001). The attributable mortality was estimated as 35.2%. Of the 54 Acinetobacter isolates, 44 (81.5%) were resistant to two or more different antibiotic classes. Conclusion: In critically ill patients, Acinetobacter bacteremia is associated with a significantly increased mortality rate. Central venous catheter insertion, mechanical ventilation, long length of hospital stay and concomitant metabolic disease were risk factors for the presence of bacteremia.

Kaynakça

  • Peleg AY, Seifert H, Paterson DL. Acinetobacter baumanii: Emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538-582.
  • Joly-Guillou ML. Clinical impact and pathogenicity of Acineto- bacter. Clin Microbiol Infect 2005;11:868-873.
  • Inan A, Ozgultekin A, Akcay SS, et al. Alterations in bacterial spectrum and increasing resistance rates in isolated micro- organisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010). Jpn J Infect Dis 2012;65:146-151.
  • Pérez F, Hujer AM, Hujer KM, et al. Global challenge of mul- tidrug resistant Acinetobacter baumanii. Antimicrob Agents Chemother 2007;51:3471-3484.
  • Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 2003;29:471-475.
  • Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control stud- ies. Crit Care 2006; 10:1-8.
  • Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Aci- netobacter baumanii in intensive care unit patients: risk fac- tors for acquisition, infection and their consequences. J Hosp Infect 2007;65:204-211.
  • Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients; a matched cohort study. Intens Care Med 2003; 29: 471-475.
  • Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-140.
  • Knaus WA, Drapier EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
  • ClinicalandLaboratoryStandardsInstitute(CLSI). Performance standards for antimicrobial susceptibility testing: Twenty-first informational supplement-Volume 31, Number 1, Clinical and Laboratory Standards Institute, Wayne, PA, USA; 2011.
  • Munoz-Price LS, Weisntein RA. Acinetobacter infection. N Engl J Med 2008;358:1271-1281.
  • Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J. Risk factors for Acinetobacter baumannii nosocomial bacte- remia in critically ill patients: a cohort study. Clin Infect Dis 2001;33:939-946.
  • Jung JY, Park MS, Kim SE, et al. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis 2010;10:228.
  • Jang TN, Lee SH, Huang CH, et al. Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit: a case-control study. J Hosp Infect 2009;73:143-150.
  • Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, et al. Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med 1999, 27: 1794-1799.
  • Garnacho-Montero J, Amaya-Villar R. Multiresistant Acineto- bacter baumannii infections: epidemiology and manage- ment. Curr Opin Infect Dis 2010;23:332-339.
  • Dizbay M, Tunccan OG, Sezer BE, Hizel K. Nosocomial imipenem-resistant Acinetobacter baumannii infections: epi- demiology and risk factors. Scand J Infect Dis 2010;42:741– 746.
  • Metan G, Sariguzel F, Sumerkan B. Factors influencing sur- vival in patients with multi-drug-resistant Acinetobacter bac- teraemia. Eur J Intern Med. 2009;20:540-544.
  • Tigen ET, Koltka EN, Dogru A, et al. Impact of the initiation time of colistin treatment for Acinetobacter infections. J Infect Chemother 2013;19:703-708.
  • Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream in- fections in critically ill patients: excess length of stay, extra cost, and attributable mortality. JAMA 1994;271:1598-1601.
  • Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309-317.
  • Grupper M, Sprecher H, Mashiach T, Finkelstein R. Attribut- able mortality of nosocomial Acinetobacter bacteremia. In- fect Control Hosp Epidemiol 2007; 28:293-298.
  • Ulu-Kılıc A, Ergönül O, Kocagül-Çelikbaş A, Dokuzoğuz B. Predictors of Mortality in Acinetobacter baumannii Bactere- mia. Klimik Dergisi 2011;24:162-166.

Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients

Yıl 2013, , 157 - 162, 01.12.2013
https://doi.org/10.5799/ahinjs.02.2013.04.0101

Öz

Amaç: Bu çalışma yoğun bakımda gelişen hastane kökenli Acinetobacter bakteriyemilerinde risk faktörlerinin belirlenmesi, hastalığın klinik sonuçlarının ve bakteriyemiye atfedilen mortalitenin saptanması için yapıldı.Yöntemler: Çalışma, 300 yataklı üçüncü basamak bir üniversite hastanesinde retrospektif vaka kontrollü (1:1) olarak gerçekleştirildi. Kontrol grubu; kan kültürü negatif, yaş (± 10), cins, birincil ve ikincil tanıları, operasyon öyküleri ve başvuru zamanları vaka grubu ile eşleşen 54 ardışık hastadan oluşturuldu.Bulgular: Hasta grubunda ortalama yatış süresi kontrol grubuna göre uzundu (sırasıyla 25.0 ve 8,0 gün, p=0,001). Acinetobacter bakteriyemisi olan hastalarda hemodinamik instabilite (hipoksi, şok) daha sık gözlendi (p=0,001). Mekanik ventilasyon, santral venöz kateterizasyon, anemi, trombositopeni, hipoalbüminemi ve kreatinin klirensinde bozulma gibi risk faktörleri hasta grubunda kontrol grubuna göre fazlaydı (p<0,004). Kontrol grubunda 14 (% 25,9) hasta kaybedilirken, hasta grubunda bu sayı 33 (% 61,1) olarak bulundu (p=0.001). Atfedilen mortalite % 35,2 olarak hesaplandı. Ellidört Acinetobacter izolatının 44’ü (% 81,5) iki ve daha fazla antibiyotik grubuna dirençliydi.Sonuçlar: Acinetobacter bakteriyemisi özellikle kritik hastalarda mortaliteyi belirgin olarak arttırmaktadır. Santral venöz kateter varlığı, mekanik ventilasyon, uzun hastanede yatış süresi, eşlik eden metabolik hastalıklar bakteriyemi için risk faktörleridir

Kaynakça

  • Peleg AY, Seifert H, Paterson DL. Acinetobacter baumanii: Emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538-582.
  • Joly-Guillou ML. Clinical impact and pathogenicity of Acineto- bacter. Clin Microbiol Infect 2005;11:868-873.
  • Inan A, Ozgultekin A, Akcay SS, et al. Alterations in bacterial spectrum and increasing resistance rates in isolated micro- organisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010). Jpn J Infect Dis 2012;65:146-151.
  • Pérez F, Hujer AM, Hujer KM, et al. Global challenge of mul- tidrug resistant Acinetobacter baumanii. Antimicrob Agents Chemother 2007;51:3471-3484.
  • Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 2003;29:471-475.
  • Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control stud- ies. Crit Care 2006; 10:1-8.
  • Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Aci- netobacter baumanii in intensive care unit patients: risk fac- tors for acquisition, infection and their consequences. J Hosp Infect 2007;65:204-211.
  • Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients; a matched cohort study. Intens Care Med 2003; 29: 471-475.
  • Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-140.
  • Knaus WA, Drapier EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
  • ClinicalandLaboratoryStandardsInstitute(CLSI). Performance standards for antimicrobial susceptibility testing: Twenty-first informational supplement-Volume 31, Number 1, Clinical and Laboratory Standards Institute, Wayne, PA, USA; 2011.
  • Munoz-Price LS, Weisntein RA. Acinetobacter infection. N Engl J Med 2008;358:1271-1281.
  • Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J. Risk factors for Acinetobacter baumannii nosocomial bacte- remia in critically ill patients: a cohort study. Clin Infect Dis 2001;33:939-946.
  • Jung JY, Park MS, Kim SE, et al. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis 2010;10:228.
  • Jang TN, Lee SH, Huang CH, et al. Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit: a case-control study. J Hosp Infect 2009;73:143-150.
  • Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, et al. Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med 1999, 27: 1794-1799.
  • Garnacho-Montero J, Amaya-Villar R. Multiresistant Acineto- bacter baumannii infections: epidemiology and manage- ment. Curr Opin Infect Dis 2010;23:332-339.
  • Dizbay M, Tunccan OG, Sezer BE, Hizel K. Nosocomial imipenem-resistant Acinetobacter baumannii infections: epi- demiology and risk factors. Scand J Infect Dis 2010;42:741– 746.
  • Metan G, Sariguzel F, Sumerkan B. Factors influencing sur- vival in patients with multi-drug-resistant Acinetobacter bac- teraemia. Eur J Intern Med. 2009;20:540-544.
  • Tigen ET, Koltka EN, Dogru A, et al. Impact of the initiation time of colistin treatment for Acinetobacter infections. J Infect Chemother 2013;19:703-708.
  • Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream in- fections in critically ill patients: excess length of stay, extra cost, and attributable mortality. JAMA 1994;271:1598-1601.
  • Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309-317.
  • Grupper M, Sprecher H, Mashiach T, Finkelstein R. Attribut- able mortality of nosocomial Acinetobacter bacteremia. In- fect Control Hosp Epidemiol 2007; 28:293-298.
  • Ulu-Kılıc A, Ergönül O, Kocagül-Çelikbaş A, Dokuzoğuz B. Predictors of Mortality in Acinetobacter baumannii Bactere- mia. Klimik Dergisi 2011;24:162-166.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Makaleler
Yazarlar

Özlem Tünger Bu kişi benim

Gönül Keleş Bu kişi benim

Şebnem Şenol Bu kişi benim

Çiğdem Banu Çetin Bu kişi benim

Hörü Gazi Bu kişi benim

Sümeyra Çoban Bu kişi benim

İlkay Aras Bu kişi benim

Melek Çivi Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2013
Yayımlandığı Sayı Yıl 2013

Kaynak Göster

APA Tünger, Ö., Keleş, G., Şenol, Ş., Çetin, Ç. B., vd. (2013). Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients. Journal of Microbiology and Infectious Diseases, 3(04), 157-162. https://doi.org/10.5799/ahinjs.02.2013.04.0101
AMA Tünger Ö, Keleş G, Şenol Ş, Çetin ÇB, Gazi H, Çoban S, Aras İ, Çivi M. Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients. J Microbil Infect Dis. Aralık 2013;3(04):157-162. doi:10.5799/ahinjs.02.2013.04.0101
Chicago Tünger, Özlem, Gönül Keleş, Şebnem Şenol, Çiğdem Banu Çetin, Hörü Gazi, Sümeyra Çoban, İlkay Aras, ve Melek Çivi. “Risk Factors for Nosocomial Acinetobacter Bacteremia: A Case-Control Study of Intensive Care Unit Patients”. Journal of Microbiology and Infectious Diseases 3, sy. 04 (Aralık 2013): 157-62. https://doi.org/10.5799/ahinjs.02.2013.04.0101.
EndNote Tünger Ö, Keleş G, Şenol Ş, Çetin ÇB, Gazi H, Çoban S, Aras İ, Çivi M (01 Aralık 2013) Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients. Journal of Microbiology and Infectious Diseases 3 04 157–162.
IEEE Ö. Tünger, “Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients”, J Microbil Infect Dis, c. 3, sy. 04, ss. 157–162, 2013, doi: 10.5799/ahinjs.02.2013.04.0101.
ISNAD Tünger, Özlem vd. “Risk Factors for Nosocomial Acinetobacter Bacteremia: A Case-Control Study of Intensive Care Unit Patients”. Journal of Microbiology and Infectious Diseases 3/04 (Aralık 2013), 157-162. https://doi.org/10.5799/ahinjs.02.2013.04.0101.
JAMA Tünger Ö, Keleş G, Şenol Ş, Çetin ÇB, Gazi H, Çoban S, Aras İ, Çivi M. Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients. J Microbil Infect Dis. 2013;3:157–162.
MLA Tünger, Özlem vd. “Risk Factors for Nosocomial Acinetobacter Bacteremia: A Case-Control Study of Intensive Care Unit Patients”. Journal of Microbiology and Infectious Diseases, c. 3, sy. 04, 2013, ss. 157-62, doi:10.5799/ahinjs.02.2013.04.0101.
Vancouver Tünger Ö, Keleş G, Şenol Ş, Çetin ÇB, Gazi H, Çoban S, Aras İ, Çivi M. Risk factors for nosocomial Acinetobacter bacteremia: a case-control study of intensive care unit patients. J Microbil Infect Dis. 2013;3(04):157-62.