Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study.

Autor: Russo A; Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy., Bassetti M; Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy., Ceccarelli G; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università 37, 00161 Rome, Italy., Carannante N; First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy., Losito AR; Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy., Bartoletti M; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., Corcione S; Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy., Granata G; Clinical and Research Department for Infectious Diseases, Unit Systemic and Immunedepression-Associated Infections, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy., Santoro A; Clinic of Infectious Disease, University Hospital, Modena, Italy., Giacobbe DR; Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy., Peghin M; Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy., Vena A; Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy., Amadori F; Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy., Segala FV; Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy., Giannella M; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., Di Caprio G; First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy., Menichetti F; Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy., Del Bono V; Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy., Mussini C; Clinic of Infectious Disease, University Hospital, Modena, Italy., Petrosillo N; Clinical and Research Department for Infectious Diseases, Unit Systemic and Immunedepression-Associated Infections, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy., De Rosa FG; Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy., Viale P; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., Tumbarello M; Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy., Tascini C; First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy., Viscoli C; Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy., Venditti M; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università 37, 00161 Rome, Italy. Electronic address: mario.venditti@uniroma1.it.
Jazyk: angličtina
Zdroj: The Journal of infection [J Infect] 2019 Aug; Vol. 79 (2), pp. 130-138. Date of Electronic Publication: 2019 May 28.
DOI: 10.1016/j.jinf.2019.05.017
Abstrakt: Objectives: bloodstream infections (BSI) due to multidrug-resistant (MDR) Acinetobacter baumannii (AB) have been increasingly observed among hospitalized patients.
Methods: prospective, observational study conducted among 12 large tertiary-care hospitals, across 7 Italian regions. From June 2017 to June 2018 all consecutive hospitalized patients with bacteremia due to MDR-AB were included and analyzed in the study.
Results: During the study period 281 episodes of BSI due to MDR-AB were observed: 98 (34.8%) episodes were classified as primary bacteremias, and 183 (65.2%) as secondary bacteremias; 177 (62.9%) of them were associated with septic shock. Overall, 14-day mortality was observed in 172 (61.2%) patients, while 30-day mortality in 207 (73.6%) patients. On multivariate analysis, previous surgery, continuous renal replacement therapy, inadequate source control of infection, and pneumonia were independently associated with higher risk of septic shock. Instead, septic shock and Charlson Comorbidity Index >3 were associated with 14-day mortality, while adequate source control of infection and combination therapy with survival. Finally, septic shock, previous surgery, and aminoglycoside-containing regimen were associated with 30-day mortality, while colistin-containing regimen with survival.
Conclusions: BSI caused by MDR-AB represents a difficult challenge for physicians, considering the high rates of septic shock and mortality associated with this infection.
(Copyright © 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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