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Clinical Outcomes of Carbapenem-Resistant Acinetobacter baumannii Bloodstream Infections: Study of a 2-State Monoclonal Outbreak

Published online by Cambridge University Press:  02 January 2015

L. Silvia Munoz-Price ,
Teresa Zembower ,
Sudhir Penugonda ,
Paul Schreckenberger ,
Mary Alice Lavin ,
Sharon Welbel ,
Dana Vais ,
Mirza Baig ,
Sunita Mohapatra  and
John P. Quinn
...Show all authors
L. Silvia Munoz-Price*
Affiliation:
University of Miami, Miami, Florida Jackson Memorial Hospital, Miami, Florida
Teresa Zembower
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Sudhir Penugonda
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Paul Schreckenberger
Affiliation:
Loyola University, Maywood, Chicago, Illinois
Mary Alice Lavin
Affiliation:
Rush University, Chicago, Illinois
Sharon Welbel
Affiliation:
John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
Dana Vais
Affiliation:
Rush University, Chicago, Illinois John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
Mirza Baig
Affiliation:
Mount Sinai Hospital, Chicago, Illinois
Sunita Mohapatra
Affiliation:
Mount Sinai Hospital, Chicago, Illinois
John P. Quinn
Affiliation:
Pfizer Global Research and Development, Groton, Connecticut
Robert A. Weinstein
Affiliation:
Rush University, Chicago, Illinois John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
*
Jackson Memorial Hospital, Park Plaza West L-302, 1611 NW 12th Avenue, Miami, FL 33136, (smunozprice@med.miami.edu)
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Extract

Objective.

To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.

Design.

Multicenter observational study.

Setting.

Four tertiary care hospitals and 1 long-term acute care hospital.

Methods.

A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.

Results.

We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality.

Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36–86 days).

Conclusions.

To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 10 , October 2010 , pp. 1057 - 1062
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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