Epidemiology and Infection

Table of Contents - March 2011 - Volume 139, Issue 03  

Bacterial infections/HAI

Risk factors for 30-day mortality in patients with carbapenem-resistant Acinetobacter baumannii during an outbreak in an intensive care unit

C. G. PRATESa1a2, A. F. MARTINSa1, S. V. SUPERTIa3, F. S. LOPESa2, F. RAMOSa2a4, V. V. CANTARELLIa5 and A. P. ZAVASCKIa4a6 c1

a1 Medical Sciences Postgraduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

a2 Hospital Epidemiology and Infection Control Service, Hospital Ernesto Dornelles, Porto Alegre, Brazil

a3 Microbiology Laboratory, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

a4 Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

a5 Weinmann Laboratory, Porto Alegre, Brazil

a6 Internal Medicine Service, Hospital de Clínicas de Porto Alegre, Brazil

SUMMARY

This study assessed risk factors for 30-day mortality in 66 patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infection or colonization during an outbreak in an intensive-care unit. Clinical and demographic characteristics were evaluated. The overall 30-day mortality was 47·0%. In the multivariate Cox regression model, septic shock [adjusted hazard ratio (aHR) 5·01, 95% confidence interval (CI) 2·32–10·01] and APACHE II score at onset of infection (aHR 1·11, 95% CI 1·04–1·18) were significantly associated with 30-day mortality. Administration of appropriate therapy was a protective factor, but it was not statistically significant (aHR 0·48, 95% CI 0·21–1·12). A sample of isolates tested (n=27) carried the blaOXA-23 gene. Severity of baseline condition and severity of infection presentation were major risk factors for mortality during the outbreak. Patients who received appropriate therapy tended to have lower mortality rates, although therapy was started late and dosage was suboptimal in most cases.

(Accepted April 30 2010)

(Online publication June 01 2010)

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c1 Author for correspondence: Dr A. P. Zavascki, Internal Medicine Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, 90.035-903, Brazil. (Email: azavascki@hcpa.ufrgs.br)

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