Predictors of mortality in solid-organ transplant recipients with infections caused by Acinetobacter baumannii

Abstract

Hua Liu,1 Qifa Ye,2,3 Qiquan Wan,2 Jiandang Zhou41Central Sterile Supply Department, 2Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, 3Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 4Department of Clinical Laboratory of Microbiology, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of ChinaAbstract: Acinetobacter baumannii can cause a serious infection in solid-organ transplant (SOT) recipients, and more data on A. baumannii infection is needed. We sought to investigate the epidemiology and distribution of A. baumannii isolates in SOT recipients. We also investigated the risk factors for overall in-hospital mortality and infection-related 30-day mortality using multivariate logistic regression analysis. A double-center retrospective study of SOT recipients who were infected with A. baumannii between January 2003 and January 2015 was conducted. A total of 71 individuals developed 93 episodes of A. baumannii infection, with a mean age of 44.5 years (44.5±11.9 years). Ninety percent of recipients had nosocomial origin A. baumannii infection, with the bloodstream as the most common site of infection (32.4%). Septic shock developed in 23.9% (17 of 71) of all recipients with A. baumannii infection. Morbidity and mortality rates of A. baumannii infections were high in SOT recipients. The incidence rate of A. baumannii infection in SOT recipients was 3.9% (71 of 1,821). Overall in-hospital mortality and infection-related 30-day mortality were 53.5% (38 of 71) and 40.8% (29 of 71), respectively. Risk factors independently associated with overall in-hospital mortality were mechanical ventilation at onset of A. baumannii infection (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.48–26.85; P=0.013), liver or liver–kidney transplantation (OR 15.33, 95% CI 1.82–129.18; P=0.012), and late-onset A. baumannii infection (OR 7.61, 95% CI 1.07–54.36; P=0.043). A platelet count <50,000/mm3 (OR 12.76, 95% CI 1.28–126.81; P=0.030) and mechanical ventilation at onset of A. baumannii infection (OR 189.98, 95% CI 13.23–2,728.81; P<0.001) were identified as independent risk factors for infection-related 30-day mortality. In conclusion, the morbidity and mortality rates of A. baumannii infections were high in SOT recipients. Mechanical ventilation at onset of A. baumannii infection was associated with higher overall in-hospital mortality and infection-related mortality. For overall in-hospital mortality, liver or liver–kidney transplantation and late-onset A. baumannii infection, and for infection-related mortality, thrombocytopenia were also risk factors, respectively.Keywords: A. baumannii, infection, predictors, mortality, solid-organ transplantation