Should we treat patients with only one set of positive blood cultures for extensively drug-resistant Acinetobacter baumannii the same as multiple sets?
Journal
PLoS ONE
Journal Volume
12
Journal Issue
7
Pages
e0180967
Date Issued
2017
Author(s)
Yang C.-J.
Chang H.-T.
Yang J.-L.
Abstract
Acinetobacter species are not considered skin commensals and under-treatment is an overriding concern when caring for critically-ill patients who are mostly at risk of extensively drug-resistant Acinetobacter baumannii (XDRAB) infections. Hence even a single blood culture yielding XDRAB will tend to prompt intervention. However, field observations suggest that patients with single-positive blood cultures had milder disease and were more likely to be recruited in interventional studies than those with multiple-positive blood cultures, yet no distinction is made in current clinical or trial recruitment practices. To our knowledge, this is the first study to compare the clinical characteristics and outcomes of patients with single-positive versus multiple-positive blood cultures for XDRAB. In this multicenter prospective cohort study of XDRAB bacteremic patients from July 2010 to June 2015, only patients with at least two simultaneously drawn blood cultures were included. The patients were classified as having single-positive or multiple-positive blood cultures according to the number of positive blood cultures yielding XDRAB. The primary end-point was the 28-day mortality. Of a total of 155 patients enrolled, 69 had a single-positive and 86 had multiple-positive blood cultures. Leukopenia (37.2% vs. 16.2%; P = 0.004), thrombocytopenia (56.0% vs. 26.5%; P < 0.001), higher Pitt bacteremia scores (6.6 vs. 5.5, P = 0.03) and higher 28-day mortality rates (70.9% vs. 43.5%; P = 0.001) distinguished patients with multiple-positive from those with single-positive cultures. Multivariate logistic regression showed that multi-positivity independently predicted 28-day mortality (adjusted odds ratio, 2.34; 95% confidence interval (CI), 1.03–5.28; P = 0.04) and the Cox regression confirmed that multi-positivity (adjusted hazard ratio, 1.80; 95% CI, 1.13–2.85; P = 0.01) predicted rapid mortality. Patients with multiple versus single positive blood cultures yielding XDRAB had greater morbidity and mortality. Investigators and clinicians should be aware that the blood culture positivity rate impacts outcomes of XDRAB bacteremia. ? 2017 Cheng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
Acinetobacter baumannii; Acinetobacter infection; adult; aged; Article; bacteremia; blood analysis; blood culture; clinical feature; cohort analysis; drug resistance; extensively drug resistant Acinetobacter baumannii infection; female; human; leukopenia; major clinical study; male; middle aged; morbidity; mortality rate; outcome assessment; prediction; prospective study; thrombocytopenia; Acinetobacter baumannii; Acinetobacter Infections; bacteremia; blood culture; clinical trial; critical illness; drug effects; growth, development and aging; intensive care unit; leukopenia; microbial sensitivity test; mortality; multicenter study; multidrug resistance; pathogenicity; pathology; procedures; severity of illness index; survival analysis; thrombocytopenia; very elderly; antiinfective agent; carbapenem derivative; colistin; Acinetobacter baumannii; Acinetobacter Infections; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blood Culture; Carbapenems; Colistin; Critical Illness; Drug Resistance, Multiple, Bacterial; Female; Humans; Intensive Care Units; Leukopenia; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Severity of Illness Index; Survival Analysis; Thrombocytopenia
Publisher
Public Library of Science
Type
journal article