Multicenter Study of the Risk Factors and Outcomes of Bloodstream Infections Caused by Carbapenem-Non-Susceptible <i>Acinetobacter baumannii</i> in Indonesia

The prevalence of bacteremia caused by carbapenem-non-susceptible <i>Acinetobacter baumannii</i> (CNSAB) continues to increase, and it is associated with a high mortality rate. Early recognition of infection and mortality determinants risk factors is necessary for adequate antibiotic adm...

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Bibliographic Details
Main Authors: Dewi Anggraini, Dewi Santosaningsih, Pepy Dwi Endraswari, Novira Jasmin, Fajri Marindra Siregar, Usman Hadi, Kuntaman Kuntaman
Format: Article
Language:English
Published: MDPI AG 2022-07-01
Series:Tropical Medicine and Infectious Disease
Subjects:
Online Access:https://www.mdpi.com/2414-6366/7/8/161
Description
Summary:The prevalence of bacteremia caused by carbapenem-non-susceptible <i>Acinetobacter baumannii</i> (CNSAB) continues to increase, and it is associated with a high mortality rate. Early recognition of infection and mortality determinants risk factors is necessary for adequate antibiotic administration. We aimed to determine the risk factors and outcomes of CNSAB bacteremia in Indonesia. A multicenter case-control study was conducted in three referral hospitals in Indonesia. Data were collected retrospectively from January 2019 to December 2021. Cases were defined as patients with bacteremia where CNSAB was isolated from the blood, while the controls were patients with bacteremia caused by carbapenem-susceptible <i>A. baumannii</i> (CSAB). Risk factors for bacteremia and mortality associated with CNSAB bacteremia were determined using univariates analysis (chi-squared and Student’s <i>t</i>-test or Mann–Whitney test) and multivariate logistic regression analysis. A total of 144 bacteremia patients were included, of whom 72 patients were for each case and control group. The final model of multivariate regression analysis revealed that bacteremia source from the lower respiratory tract (adjusted odds ratio (aOR): 3.24; 95% CI: 1.58–6.63, <i>p</i> = 0.001) and the use of central venous catheter (aOR: 2.56; 95% CI: 1.27–5.18; <i>p</i> = 0.009) were independent risk factors for CNSAB bacteremia. Charlson Comorbidity Index ≥ 4 (aOR: 28.56; 95% CI: 3.06–265.90, <i>p</i> = 0.003) and Pitt Bacteremia Score ≥ 4 (aOR: 6.44; 95% CI: 1.17–35.38; <i>p</i> = 0.032) were independent risk factors for mortality due to CNSAB bacteremia. Only high Pitt Bacteremia Score was an independent risk factor for mortality of CSAB bacteremia. In conclusion, we identified the risk factors for CNSAB-associated bacteremia and the risk factors for death, which are relevant for empiric therapy and infection control prevention, as well as prognosis evaluation of patients with bloodstream infections.
ISSN:2414-6366