Mortality due to carbapenem-resistant Acinetobacter baumannii bacteraemia: a five-year cohort study in intensive care patients
Abstract
OBJECTIVES
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a major and difficult-to-treat nosocomial pathogen. This study estimated the mortality associated with CRAB bacteraemia in patients receiving treatment in the intensive care unit. A susceptible-infection counterfactual framework was applied to reflect the potential benefit of improved antimicrobial therapy.
METHODS
A five-year (2019-2023) cohort study was conducted in a tertiary-care referral hospital in Greece. Competing risks survival analysis methods were applied to estimate excess in-hospital mortality due to CRAB bacteraemia by comparing patients infected by CRAB to those infected by other more susceptible Gram-negative bacteria (GNB).
RESULTS
The cohort comprised 400 intensive care patients with GNB bacteraemia (median age 70 years, 65% male). CRAB was the most common pathogen (43%), followed by K. pneumoniae (12%), E. coli (11%), and P. aeruginosa (10%). Patients with CRAB bacteraemia experienced significantly higher in-hospital mortality at 14 days (35% vs. 21%), 28 days (53% vs. 30%) and overall (74% vs. 52%) compared to patients with other GNB bacteraemia. Multivariable competing-risks regression confirmed that CRAB bacteraemia was independently associated with increased risk of 28-day inpatient death (cause-specific hazard ratio [csHR] 1.80, 95% CI 1.28-2.54; sub-distribution hazard ratio [sHR] 1.84, 95% CI 1.28-2.62), simultaneously lowering the probability of discharge alive (csHR…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 400 participants or records.
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