Acinetobacter baumanii (A. baumannii) infection among hospitalized cancer patients is associated with high morbidity and mortality. Recent literature has described the emergence of A. baumanii that are resistant to most standard first-line antibiotics. We sought to identify the risk factors and outcomes for A. baumanii infection among cancer patients admitted to the intensive care unit (ICU) of a cancer center in Pakistan.
We reviewed the medical records of all cancer patients who had A.baumannii on various clinical samples and who were admitted to the ICU over a period of 24 months. We also reviewed records of every second patient who was admitted in ICU during the same time period and stayed there for more than 48 hours. Demographic and baseline clinical characteristics, duration of ICU care before and after getting A.baumannii infection, history of antibiotic use, and outcomes were compared for patients with a positive culture to those with a negative culture. Logistic regression analyses were used to identify the risk factors for A. baumaniiinfection.
A total of 198 ICU patients fulfilling inclusion criteria were reviewed over a period of 24 months. Of these, 61 (30.8%) had a positive culture for A. baumanni. A fourth of the patients (26.3%) were younger than 18 years old, and 62.1% were males. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score among those with a positive culture was 23.78 while it was 22.78 among those who had a negative culture for A.baumannii. Patients with A.baumannii infection were significantly more likely to have received piperacillin-tazobactem or a carbapenem while controls were more likely to have received a fluoroquinolone or an aminoglycoside 4 weeks prior to the culture. Multivariate logistic regression analyses indicated that patients with A.baumannii had a significantly higher odds of being on a ventilator (adjusted odds ratio 46.0). Survival at 4 weeks was 16.4% among patients with a positive culture while 33.3% among those with a negative culture.
Our study revealed that prolonged ICU stay, being on ventilator and use of piperacillin-tazobactam and carbapenems in prior 1 month were significantly associated with the acquisition of A. baumanni infection. These patients had a longer hospital stay and a higher mortality compared to the control group.
F. Sultan, None
S. H. Nazeer, None
I. Mobein, None
W. Zafar, None