Early source control may reduce mortality in multidrug-resistant A baumannii bloodstream infection

  • Russo A & al.
  • J Infect
  • 7 Aug 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Comorbidities, septic shock, and inadequate source control increase 30-day mortality risk in hospitalized patients with multidrug-resistant Acinetobacter baumannii (MDR-AB) bloodstream infections (BSIs).

Why this matters

  • While there is a dearth of data explaining high mortality rates among MDR-AB patients, adequate, early source control and avoidance of aerosolized colistin may help improve outcomes among patients with concomitant pneumonia.

Key results

  • Among 281 MDR-AB BSIs, 34.8% (98), 65.2% (183) were classified as primary, secondary bacteremia, respectively.
  • 62.9% (177) were associated with septic shock.
  • 98.6% of strains were extensively drug-resistant.
  • 14-, 30-day mortality observed in 61.2% (172) and 73.6% (207) of patients, respectively.
  • Multivariate factors: previous surgery (OR, 33.9; P<.001 continuous renal replacement therapy no source control pneumonia associated with higher septic shock risk.>
  • 14-day mortality risk factors: septic shock (HR, 10.79; P=.04), Charlson Comorbidity score >3 (HR, 1.44; P=.02).
  • 30-day mortality was 82.5% in presence of septic shock (P<.001>
  • Highest 30-day mortality rates observed in patients treated with 3-drug combination (78.3%), carbapenem- (73.1%), or colistin-containing (70.9%).

Study design

  • Prospective, observational, multicenter Italian study of 281 patients with MDR-AB BSI.
  • Funding: None.

Limitations

  • Observational.
  • Heterogeneous MDR-AB incidence across centers.
  • Underlying resistance mechanisms not captured.