Karakonstantis, S., Gikas, A., Astrinaki, E. et al. (1 more author) (2020) Excess mortality due to pandrug-resistant Acinetobacter baumannii infections in hospitalized patients. Journal of Hospital Infection, 106 (3). pp. 447-453. ISSN 0195-6701
Abstract
Background
Pandrug-resistant Acinetobacter baumannii (PDRAB) is increasingly being reported as a nosocomial pathogen worldwide, but determining its clinical impact is challenging.
Aim
To assess the spectrum of excess mortality attributable to PDRAB infection in acute care settings.
Methods
This four-year cohort study was conducted in a tertiary-care referral hospital in Greece to estimate excess in-hospital mortality due to PDRAB infection by comparing patients infected to those colonized with PDRAB by means of competing risks survival analysis.
Findings
The study cohort comprised 91 patients (median age: 67 years; 77% men). For most patients, PDRAB was first isolated in the intensive care unit (ICU) (N = 51; 57%) or following ICU discharge (N = 26; 29%). Overall in-hospital mortality was 68% (95% confidence interval (CI): 57.5–77.5%). PDRAB-infected patients (N = 62; 68%) and PDRAB-colonized patients (N = 29; 32%) had similar baseline characteristics, but the absolute excess risk of 30-day mortality in infected patients compared to colonized patients was 34% (95% CI: 14–54%). Multivariable competing risks regression showed that PDRAB infection significantly increased the daily hazard of 30-day in-hospital death (cause-specific hazard ratio (csHR): 3.10; 95% CI: 1.33–7.21) while simultaneously decreasing the daily rate of discharge (csHR: 0.24; 95% CI: 0.08–0.74), thereby leading to longer hospitalization. Stronger effects were observed for bloodstream infections.
Conclusion
New effective antimicrobials would be expected to prevent mortality in one of every three patients treated for PDRAB infection and reduce their length of hospitalization. However, available therapeutic options remain extremely limited and emphasis on preventing healthcare-associated transmission of PDRAB is ever more important.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. This is an author produced version of a paper subsequently published in Journal of Hospital Infection. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Pandrug-resistant bacteria; Acinetobacter baumannii; Hospital epidemiology; Survival; Competing risks |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 14 Oct 2022 13:26 |
Last Modified: | 14 Oct 2022 13:34 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.jhin.2020.09.009 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:192046 |
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