Natural prognosis of carbapenem-resistant Acinetobacter baumannii bacteremia in patients who did not receive appropriate antibiotic treatment: A retrospective multicenter study in Korea

Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is a major issues in current era. The aim of study was to investigate the natural prognosis and prognostic factors associated with 28-day mortality in patients with CRAB bacteremia who were not receiving appropriate antibiotic treatment. Adult patients with CRAB bacteremia were retrospectively identified between April 2012 and March 2015 at 5 tertiary hospitals in Republic of Korea. Patients who were transferred to another hospital within 28 days of onset of bacteremia and who receive appropriate antibiotics more than 48 hours were excluded. We investigated prognostic factors associated with 28-day mortality in patients with CRAB bacteremia without appropriate antibiotic treatment. Of enrolled 205 patients, 143 (69.8%) patients died within 28 days after blood culture. Of patients with 28-day mortality, 88.9% (127/143) of patients died within 5 days. Of 78 patients who survived more than 5 days, the 28-day mortality was 20.5% (16/78). Diabetes mellitus (adjusted odds ratio [aOR] 3.81, 95% confidence interval [95% CI] 1.19-12.20), immunocompromised (aOR 8.72, 95% CI 2.62-29.70), sequential organ failure assessment (SOFA) ≥ 10 (aOR 13.87, 95% CI 3.70-51.96), vasopressor use (aOR 7.03, 95% CI 1.79-27.60), and pneumonia (aOR 4.44, 95% CI 1.67-11.78) were found to be the factors independently associated with the 28-day mortality. The 28-day mortality in patients with CRAB bacteremia without appropriate treatment was high, although some patients could survive. Severity and underlying conditions were important prognostic factors in patients with CRAB bacteremia.