Predictors of Multidrug Resistant Acinetobacter Baumannii Infections in Surgical Intensive Care Patients: A Retrospective Analysis

Abstract

Objective: Multidrug resistant Acinetobacter baumannii (MRAB) is an important cause of hospital acquired infection and leads to an increasing morbidity and mortality in intensive care units (ICU). The aim of this study was to investigate the predictors of MRAB infection in surgical ICU patients. Material and Method: The charts of the patients who were admitted to the ICU between January 2008 and August 2010 were reviewed to identify patients with MRAB infection. Recorded data were as follows: age, sex, medical history, underlying surgical pathology, Acute Physiology and Chronic Health Evaluation II score (APACHE II) and Glasgow Coma Score on ICU admission,presence of invasive procedures (intubation, arterial, central venous lines, urinary catheters, and renal replacement therapy), days in ICU and white blood cells (WBC) and lactate count on infection day, infection site, complications (such as organ/system failure), length of stay (LOS) in the ICU and hospital, and final outcome. Results: During the study period 25 patients with MRAB infection were identified. When compared with their matched control group (n=25), patients with MRAB infection had a significantly higher mean APACHE II score (p=0.001) and more frequently had an open wound (p=0.002) or required mechanical ventilation (p=0.005), with respiratory system disease (p=0.03), arterial catheterization (p=0.006), and central venous catheterization (p=0.004). Multivariate logistic regression revealed that APACHE II score (OR,1.155; CI, 1.008-1.324; p= 0.038) and open wound (OR, 27.77; CI, 2.020-333.333; p=0.018) were predictors of MRAB infection in these patients. Compared to their controls, patients with MRAB infection hand a longer LOS in ICU (36.44±30.44 days vs 7.80±8.13 days, p<0.000) and hospital (55.12±40.81 days vs 19.04±13.44 days, p<0.000). In hospital mortality rates for patients with MRAB infection and their controls were 56% and 32%, respectively (p=0.154). Conclusion: Our results indicate that APACHE II score and presence of an open wound are predictors of MRAB in ICU surgical patients. Patients with MRAB infection tended to have a higher mortality and had a longer LOS in ICU and hospital than their controls. (Journal of the Turkish Society Intensive Care 2011; 9:53-8)

Keywords

• Multidrug- resistant Acinetobacter infection
• hospital- acquired infection
• intensive care unit