Prediction of the Risk of Hospital Deaths in Patients with Hospital-Acquired Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii Infection: A Multi-Center Study

Abstract

Hongmei Shu,1– 3 Lijuan Li,2 Yimin Wang,2 Yiqun Guo,4 Chunlei Wang,5 Chunxia Yang,4 Li Gu,4 Bin Cao2,5,6 1Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 3Department of Respiration, Anqing Municipal Hospital, Anqing Hospital of Anhui Medical University, Anhui 246000, People’s Republic of China; 4Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People’s Republic of China; 5Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 6Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; National Clinical Research Center of Respiratory Disease, Clinical Center for Pulmonary Infection, Capital Medical University, Tsinghua University-Peking University Joint Center for Life Sciences, Beijing 100029, People’s Republic of ChinaCorrespondence: Bin CaoDepartment of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghua East Road, Chao-Yang District, Beijing 100029, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] GuDepartment of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Worker’s Stadium South Road, Chaoyang District, Beijing 100020, People’s Republic of ChinaEmail [email protected]: To predict the risk of hospital deaths in patients with hospital-acquired pneumonia (HAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) infection.Patients and Methods: A total of 366 patients who were diagnosed with HAP caused by MDR-AB infection were enrolled between January 2013 and December 2016. The sociological characteristics and clinical data of these cases were collected. Univariate and multivariate logistic analyses were used to explore the risk factors of hospital deaths before medication and after drug withdrawal. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to assess the predictive effectiveness of the models with or without the adjustment.Results: Hospital deaths occurred in 142 cases (38.80%). The results showed that acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores before medication and after drug withdrawal were associated with the risk of hospital deaths. Adjusting the covariants including the age, autoimmune disease, venous cannula, transfer of patients from other hospitals, and APACHE II score at admission, then no differences were discovered in predicting the hospital deaths between adjusted APACHE II and adjusted SOFA scores before medication (AUC: 0.808 vs 0.803, P =0.614) and after drug withdrawal (AUC: 0.876 vs 0.878, P =0.789).Conclusion: Before medication or after drug withdrawal, the adjusted APACHE II and adjusted SOFA scores all performed well in determining the predictive effectiveness of the hospital deaths in patients with HAP caused by MDR-AB infection, indicating that the appropriate infection control may reduce the occurrence of nosocomial deaths and improve the prognosis.Keywords: multidrug-resistant Acinetobacter baumaii, hospital-acquired pneumonia, intensive care units, hospital deaths

Keywords

• multidrug-resistant acinetobacter baumaii
• hospital-acquired pneumonia
• intensive care units
• hospital deaths