Methods: This prospective cohort study was conducted among adult (age>18 years) patients admitted to the intensive care units (ICUs) of a 2500-bed tertiary care hospital in southern India from January 2013 to June 2014. We enrolled patients who developed new-onset fever ≥48 hours after admission, and fulfilled criteria for VAP or CR-BSI. The patient was diagnosed to have a VAP if the Clinical Pulmonary Infection Score was ≥6 on the day of new onset fever or changed from <6 to ≥6 within 72 hours after fever onset with compatible organism on endotracheal aspirate culture and no other focus of infection. CR-BSI was diagnosed based on the National Healthcare Safety Network criteria. The patients were followed up until death or discharge from the hospital. The primary outcome was death and secondary outcome was ventilator-free days to day 28
Results:During the study period, 4047 patients were admitted in the ICUs among whom 126 HAI events occurred. Of these,93(73.8%) were VAP and 33(26.1%)were CR-BSI. Of the 126 HAIs,77(61%) were Acinetobacter related HAI (AR-HAI) and 49(39%)were non-Acinetobacter related HAI (NAR-HAI). Acinetobacter caused 67(72%)episodes of VAP. Mortality in the AR-HAI group was 57.1%, compared to 40.8% in the NAR-HAI (OR 1.93,95%CI0.935-3.99,p=0.074). On univariate analysis the factors associated with mortality were: the admission diagnosis, the APACHE scores at the time of HAI acquisition and AR-HAI. Multivariate analysis showed that the only factor significantly associated with mortality was the admission diagnosis. The higher mortality among AR-HAI did not achieve statistical significance. However AR-HAI(OR3.9,CI1.01-11.4,p-0.04)and admission diagnosis(OR13.9,CI3.2-44.1,p-<0.001)were associated with poorer ventilator outcomes.
Conclusion: In our cohort of critically-ill adult patients with VAP and CR-BSI, infections with Acinetobacter were associated with poorer ventilator outcomes and a trend towards higher mortality
A. O. John,