Risk Factors for Development and Mortality of Bloodstream Infections Caused by Carbapenem-Resistant Acinetobacter baumannii

Liubing Li,1,&ast; Dubo Chen,1,&ast; Pingjuan Liu,1,&ast; Luqi Dai,2 Zhaoxia Tang,3 Siting Yi,1 Mengmin Ye1 1Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 3Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mengmin Ye; Siting Yi, Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China, Email [email protected]; [email protected]: Bloodstream infections (BSIs) caused by Acinetobacter baumannii (AB), especially carbapenem-resistant Acinetobacter baumannii (CRAB), can lead to a high patient mortality rate.Methods: This study aimed to analyze the clinical data and prognosis of 191 patients with AB-BSI hospitalized in Southern China from January 2017 to December 2023.Results: CRAB was diagnosed in 128 (67.0%) of the 191 patients with AB-BSI. Endotracheal intubation (OR = 23.957, 95% CI: 5.123– 112.022, P < 0.001), carbapenem treatment (OR = 6.422, 95% CI: 1.554– 26.542, P = 0.010) and ≥ 2 antimicrobial drugs therapy (OR = 6.131, 95% CI: 1.763– 21.324, P = 0.004) prior to the onset of BSI were independent risk factors for the development of CRAB-BSI, as revealed by the binary logistic regression analysis. The overall mortality rate of patients with AB-BSI was 27.7%, while that of patients with CRAB was significantly higher than that of patients with carbapenem-sensitive Acinetobacter baumannii (CSAB) (39.1% vs 4.8%, P < 0.001). Multivariate Cox regression analysis revealed septic shock (HR = 3.664, 95% CI: 1.537– 8.736, P = 0.003) as an independent risk factor for mortality in CRAB-BSI patients. Kaplan–Meier survival analysis showed a significantly lower 28-day survival rate for CRAB-BSI patients who developed septic shock compared to those who did not (58.4% vs 87.1%, P = 0.001).Conclusion: Clinicians should closely monitor patients at high risk for CRAB-BSI, focusing on invasive procedure management and antimicrobial stewardship. Timely supportive care is crucial for CRAB-BSI patients at risk of septic shock to improve survival outcomes.Keywords: risk factors, bloodstream infections, carbapenem-resistant Acinetobacter baumannii