Background: Acinetobacter baumannii has become a common pathogen causing hospital-acquired infections (HAIs). Although acquiring any nosocomial infection is associated with increased mortality, we do not know if the acquisition of Acinetobacter infection confers a worse prognosis as compared to non-Acinetobacter-related HAI. The aim of the current study is to compare the clinical outcomes of ventilator-associated pneumonia (VAP) and central line associated blood stream infections (CLABSIs) caused by A. baumannii with those caused by other bacterial pathogens. Materials and Methods: This prospective cohort study was conducted among critically ill adults admitted to a tertiary care hospital in South India from January 2013 to June 2014. We enrolled patients who developed new-onset fever ≥48 h after admission and fulfilled pre-specified criteria for VAP or CLABSI. The patients were followed up until the primary outcomes of death or hospital discharge. Results: During the study period, 4047 patients were admitted in the intensive care units, among which 129 eligible HAI events were analysed. Of these, 95 (73.6%) were VAP, 34 (26.4%) were CLABSI, 78 (60.4%) were A. baumannii-related HAI (AR-HAI) and 51 (39.6%) were non-A. baumannii-related HAI (NAR-HAI). Mortality among AR-HAI was 57.6% compared to 39.2% in NAR-HAI (P = 0.04) which on multivariate analysis did not achieve statistical significance, although the trend persisted (odds ratio [OR] = 4.2, 95% confidence interval [CI]: 0.95–18.4, P = 0.06). The acquisition of VAP due to A. baumannii was associated with poor ventilator outcomes even after adjusting for confounders (adjusted OR = 3.5, 95% CI: 1.07–11.6, P = 0.04). Conclusion: In our cohort of critically ill adults with VAP and CLABSI, AR-HAI was associated with poor ventilator outcomes and a trend towards higher mortality. These findings add to the evidence suggesting that A. baumannii is a dangerous pathogen, perhaps even more so than others.


中文翻译：

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与印度南部重症患者其他感染相比，不动杆菌感染的死亡率：一项前瞻性队列研究。


背景： 鲍曼不动杆菌已成为引起医院获得性感染（HAIs）的常见病原体。尽管获得医院内感染与死亡率增加有关，但我们不知道与非不动杆菌相关的HAI相比，不动杆菌感染的预后是否更差。本研究的目的是比较鲍曼不动杆菌与其他细菌病原体引起的呼吸机相关性肺炎（VAP）和中心线相关性血流感染（CLABSI）的临床结局。材料和方法：这项前瞻性队列研究是对2013年1月至2014年6月在印度南部三级医院收治的危重成年人进行的研究。我们纳入了入院后48小时内出现新发烧且符合VAP或CLABSI预定标准的患者。 。对患者进行随访直至死亡或出院的主要结果。结果：在研究期间，重症监护病房收治了4047例患者，其中有129例符合条​​件的HAI事件被分析。其中95％（73.6％）是VAP，34（26.4％）是CLABSI，78（60.4％）是鲍曼不动杆菌相关的HAI（AR-HAI）和51（39.6％）是非鲍曼不动杆菌相关的海（NAR-HAI）。AR-HAI的死亡率为57.6％，而NAR-HAI的死亡率为39.2％（P= 0.04），尽管趋势仍然存在（多元比[OR] = 4.2，95％置信区间[CI]：0.95-18.4，P = 0.06），但在多变量分析中没有达到统计学显着性。即使在校正混杂因素后，由于鲍曼不动杆菌而获得的VAP与呼吸机预后不良相关（校正后的OR = 3.5，95％CI：1.07-11.6，P = 0.04）。结论：在我们的VAP和CLABSI重症成人队列中，AR-HAI与呼吸机预后不良和死亡率升高趋势相关。这些发现增加了证据，表明鲍曼不动杆菌是一种危险的病原体，也许比其他病原体更为严重。