TY - JOUR
T1 - Predictors of hospital mortality among septic ICU patients with Acinetobacter spp. bacteremia
T2 - A cohort study
AU - Shorr, Andrew F.
AU - Zilberberg, Marya D.
AU - Micek, Scott T.
AU - Kollef, Marin H.
N1 - Funding Information:
This study was supported by a grant from Tetraphase Pharmaceutical, Inc., Watertown, MA. The funder had no role in study design, analyses, data interpretation, or in the preparation or submission of the manuscript. Although the funder was given the opportunity to review the manuscript prior to submission, all of the editorial decisions resided with the authors. No one other than the listed authors contributed to the study.
Funding Information:
This study was supported by a grant from Tetraphase Pharmaceuticals, Inc., Watertown, MA; Dr. Kollef’s time was in part supported by the Barnes-Jewish Hospital Foundation. These data in part have been accepted for presentation at ID Week 2014 meeting in Philadelphia, PA, USA.
Funding Information:
MDZ has served as a consultant to and/or received research funding from Cubist, Astellas, Pfizer and CareFusion and Theravance. AFS has served as a consultant to and/or received research funding from Cubist, Astellas, Pfizer, Forest, Theravance and CareFusion. STM has served as a consultant to and/or received research funding from Cubist, Astellas and Pfizer. MHK has served as a consultant to and/or received research funding from Cubist, Astellas, Pfizer, Forest and Theravance.
Publisher Copyright:
© 2014 Shorr et al.
PY - 2014/10/30
Y1 - 2014/10/30
N2 - Background: We hypothesized that among septic ICU patients with Acinetobacter spp. bacteremia (Ac-BSI), carbapenem-resistant Acinetobacter spp. (CRAc) increase risk for inappropriate initial antibiotic therapy (non-IAAT), and non-IAAT is a predictor of hospital death. Methods: We conducted a retrospective cohort study of adult septic ICU patients with Ac-BSI. Non-IAAT was defined as exposure to initially prescribed antibiotics not active against the pathogen based on in vitro susceptibility testing, and having no exposure to appropriate antimicrobial treatment within 24 hours of drawing positive culture. We compared patients who died to those who survived, and derived regression models to identify predictors of hospital mortality and of non-IAAT. Results: Out of 131 patients with Ac-BSI, 65 (49.6%) died (non-survivors, NS). NS were older (63 [51, 76] vs. 56 [45, 66] years, p = 0.014), and sicker than survivors (S): APACHE II (24 [19, 31] vs. 18 [13, 22], p < 0.001) and Charlson (5 [2, 8] vs. 3 [1, 6], p = 0.009) scores. NS were also more likely than S to require pressors (75.4% vs. 42.4%, p < 0.001) and mechanical ventilation (75.4% vs. 53.0%, p = 0.008). Both CRAc (69.2% vs. 47.0%, p = 0.010) and non-IAAT (83.1% vs. 59.1%, p = 0.002) were more frequent among NS than S. In multivariate analyses, non-IAAT emerged as an independent predictor of hospital death (risk ratio [RR] 1.42, 95% confidence interval [CI] 1.10-1.58), while CRAc was the single strongest predictor of non-IAAT (RR 2.66, 95% CI 2.43-2.72). Conclusions: Among septic ICU patients with Ac-BSI, non-IAAT predicts mortality. Carbapenem resistance appears to mediate the relationship between non-IAAT and mortality.
AB - Background: We hypothesized that among septic ICU patients with Acinetobacter spp. bacteremia (Ac-BSI), carbapenem-resistant Acinetobacter spp. (CRAc) increase risk for inappropriate initial antibiotic therapy (non-IAAT), and non-IAAT is a predictor of hospital death. Methods: We conducted a retrospective cohort study of adult septic ICU patients with Ac-BSI. Non-IAAT was defined as exposure to initially prescribed antibiotics not active against the pathogen based on in vitro susceptibility testing, and having no exposure to appropriate antimicrobial treatment within 24 hours of drawing positive culture. We compared patients who died to those who survived, and derived regression models to identify predictors of hospital mortality and of non-IAAT. Results: Out of 131 patients with Ac-BSI, 65 (49.6%) died (non-survivors, NS). NS were older (63 [51, 76] vs. 56 [45, 66] years, p = 0.014), and sicker than survivors (S): APACHE II (24 [19, 31] vs. 18 [13, 22], p < 0.001) and Charlson (5 [2, 8] vs. 3 [1, 6], p = 0.009) scores. NS were also more likely than S to require pressors (75.4% vs. 42.4%, p < 0.001) and mechanical ventilation (75.4% vs. 53.0%, p = 0.008). Both CRAc (69.2% vs. 47.0%, p = 0.010) and non-IAAT (83.1% vs. 59.1%, p = 0.002) were more frequent among NS than S. In multivariate analyses, non-IAAT emerged as an independent predictor of hospital death (risk ratio [RR] 1.42, 95% confidence interval [CI] 1.10-1.58), while CRAc was the single strongest predictor of non-IAAT (RR 2.66, 95% CI 2.43-2.72). Conclusions: Among septic ICU patients with Ac-BSI, non-IAAT predicts mortality. Carbapenem resistance appears to mediate the relationship between non-IAAT and mortality.
KW - Acinetobacter spp
KW - Aevere sepsis
KW - Bacteremia
KW - Carbapenem resistance
KW - Inappropriate initial antibiotic therapy
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=84920848433&partnerID=8YFLogxK
U2 - 10.1186/s12879-014-0572-6
DO - 10.1186/s12879-014-0572-6
M3 - Article
C2 - 25358621
AN - SCOPUS:84920848433
SN - 1471-2334
VL - 14
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 572
ER -