GURHAN TASKIN*, KADIR OZTURK**, TURKER TURKER***, NESRIN OCAL*, MUSTAFA CAKAR****, SERHAT OZER*, LEVENT YAMANEL*
*Department of Intensive Care, Gulhane Military Medical Faculty, Ankara, Turkey -
**Department of Gastroenterology, Gulhane Military Medical Faculty, Ankara, Turkey -
***Department of Health Public and Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey -
****Department of Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey
Introduction: Acinetobacter baumannii (AB) is a gram-negative coccobacillus causing life-threatening nosocomial infections in critically ill patients. Although mortality risk factors have been investigated in previous studies, there is not sufficient data about the prognostic roles of tracheostomy and central venous catheterization (CVC) in patients with AB bacteremia. Therefore, we performed this study to assess the risk factors associated to mortality from AB bacteremia in intensive care unit (ICU) with a new perspective.
Materials and methods: Data of 90 adult patients with AB bacteremia hospitalized between 01 January 2010 and 01 December 2014 in ICU were evaluated retrospectively. The results were assessed in terms of 14th and 28th day mortality rates.
Results: The 14th day and 28th day mortality rates for patients with AB bacteremia were 31.1 % and 48.9 %, respectively. The 14th day non-survivors were more likely to have chronic kidney disease, insertion of subclavian and femoral CVC compared to survivors. While tracheostomy, jugular CVC, absence of CVC, higher serum albumin and lower procalcitonin (PCT) levels were observed significantly more common in survivors; higher high-sensitivity CRP, higher PCT, and lower albumin levels were significantly more common in mortality group. Risk factors associated with 14th day mortality were high serum PCT (p<0.001), lack of tracheostomy (p=0.004) and CVC location (p=0.007). Whereas, 28th day mortality was associated with chronic kidney disease, malignancy, insertion of subclavian and femoral CVC. High serum PCT (p<0.001), lack of tracheostomy (p=0.001) and CVC location (p=0.006) were determined as independent predictors for 28th day mortality.
Conclusion: These data reveal that lack of tracheostomy and presence of subclavian or femoral CVC are independent risk factors for 14th and 28th day mortality, and high PCT level is a good predictor for poor prognosis in ICU patients with AB bacteremia. According to our knowledge, this study contributes to current literature in terms of being the first study focused on the prognostic roles of tracheostomy and CVC in patients with AB bacteremia.
Acinetobacter baumannii, bacteremia, mortality, risk factor, central venous catheterization.