Clinical significance of multidrug-resistant Acinetobacter baumannii isolated from central venous catheter tip cultures in patients without concomitant bacteremia

Young Kyung Yoon, Jacob Lee, Seong Yeol Ryu, Hyun Ha Chang, Wonseok Choi, Ji Hyun Yoon, Jian Hur, Yu Mi Jo, Sue Yun Kim, Kyung Sook Yang, Shin Woo Kim

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Abstract

Background: The purpose of this study was to examine the clinical implications of a positive central venous catheter (CVC) tip culture with multidrug-resistant Acinetobacter baumannii (MRAB) in patients without concurrent bacteremia. Methods: This retrospective, multicenter study was conducted in 9 teaching hospitals in the Republic of Korea from May 2008 to April 2012. Study subjects included adult patients (aged ≥ 18 y) who yielded an MRAB-positive CVC tip culture without concurrent MRAB bacteremia. All patients were observed for the development of subsequent MRAB bacteremia for 6 months after CVC removal. Multivariable Firth logistic regression analysis was performed to determine predictors independently associated with subsequent MRAB bacteremia. Results: During the study period, subsequent MRAB bacteremia was observed in 18.8% of patients (21/112). Of the 112 patients, 23 (20.5%) did not show systemic inflammatory response syndrome (SIRS). None of the 23 patients without SIRS presented with subsequent MRAB bacteremia. Multivariable logistic regression analysis showed that prior administration of carbapenems (odds ratio (OR) 7.04, 95% confidence interval (CI) 1.43-34.77) or corticosteroids (OR 6.67, 95% CI 1.19-37.44), and C-reactive protein ≥ 40 mg/l (OR 18.11, 95% CI 2.22-148.07) were positive predictive factors. Prior acquisition of MRAB at a site other than the catheter (OR 0.10, 95% CI 0.03-0.39) was a negative predictive factor for developing MRAB bacteremia. Conclusions: Our results suggest that patients with a CVC tip colonized with MRAB should be closely monitored for signs and symptoms of subsequent MRAB bacteremia.

Original languageEnglish
Pages (from-to)900-906
Number of pages7
JournalScandinavian Journal of Infectious Diseases
Volume45
Issue number12
DOIs
Publication statusPublished - 2013 Dec 1

Fingerprint

Acinetobacter baumannii
Central Venous Catheters
Bacteremia
Odds Ratio
Confidence Intervals
Systemic Inflammatory Response Syndrome
Logistic Models
Regression Analysis
Republic of Korea
Carbapenems
Teaching Hospitals
C-Reactive Protein
Multicenter Studies
Signs and Symptoms
Adrenal Cortex Hormones
Catheters
Retrospective Studies

Keywords

  • Acinetobacter baumannii
  • Bacteremia
  • Catheter-related infections
  • Outcome

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology and Microbiology(all)
  • Infectious Diseases

Cite this

Clinical significance of multidrug-resistant Acinetobacter baumannii isolated from central venous catheter tip cultures in patients without concomitant bacteremia. / Yoon, Young Kyung; Lee, Jacob; Ryu, Seong Yeol; Chang, Hyun Ha; Choi, Wonseok; Yoon, Ji Hyun; Hur, Jian; Jo, Yu Mi; Kim, Sue Yun; Yang, Kyung Sook; Kim, Shin Woo.

In: Scandinavian Journal of Infectious Diseases, Vol. 45, No. 12, 01.12.2013, p. 900-906.

Research output: Contribution to journalArticle

Yoon, Young Kyung ; Lee, Jacob ; Ryu, Seong Yeol ; Chang, Hyun Ha ; Choi, Wonseok ; Yoon, Ji Hyun ; Hur, Jian ; Jo, Yu Mi ; Kim, Sue Yun ; Yang, Kyung Sook ; Kim, Shin Woo. / Clinical significance of multidrug-resistant Acinetobacter baumannii isolated from central venous catheter tip cultures in patients without concomitant bacteremia. In: Scandinavian Journal of Infectious Diseases. 2013 ; Vol. 45, No. 12. pp. 900-906.
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abstract = "Background: The purpose of this study was to examine the clinical implications of a positive central venous catheter (CVC) tip culture with multidrug-resistant Acinetobacter baumannii (MRAB) in patients without concurrent bacteremia. Methods: This retrospective, multicenter study was conducted in 9 teaching hospitals in the Republic of Korea from May 2008 to April 2012. Study subjects included adult patients (aged ≥ 18 y) who yielded an MRAB-positive CVC tip culture without concurrent MRAB bacteremia. All patients were observed for the development of subsequent MRAB bacteremia for 6 months after CVC removal. Multivariable Firth logistic regression analysis was performed to determine predictors independently associated with subsequent MRAB bacteremia. Results: During the study period, subsequent MRAB bacteremia was observed in 18.8{\%} of patients (21/112). Of the 112 patients, 23 (20.5{\%}) did not show systemic inflammatory response syndrome (SIRS). None of the 23 patients without SIRS presented with subsequent MRAB bacteremia. Multivariable logistic regression analysis showed that prior administration of carbapenems (odds ratio (OR) 7.04, 95{\%} confidence interval (CI) 1.43-34.77) or corticosteroids (OR 6.67, 95{\%} CI 1.19-37.44), and C-reactive protein ≥ 40 mg/l (OR 18.11, 95{\%} CI 2.22-148.07) were positive predictive factors. Prior acquisition of MRAB at a site other than the catheter (OR 0.10, 95{\%} CI 0.03-0.39) was a negative predictive factor for developing MRAB bacteremia. Conclusions: Our results suggest that patients with a CVC tip colonized with MRAB should be closely monitored for signs and symptoms of subsequent MRAB bacteremia.",
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AU - Yoon, Young Kyung

AU - Lee, Jacob

AU - Ryu, Seong Yeol

AU - Chang, Hyun Ha

AU - Choi, Wonseok

AU - Yoon, Ji Hyun

AU - Hur, Jian

AU - Jo, Yu Mi

AU - Kim, Sue Yun

AU - Yang, Kyung Sook

AU - Kim, Shin Woo

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background: The purpose of this study was to examine the clinical implications of a positive central venous catheter (CVC) tip culture with multidrug-resistant Acinetobacter baumannii (MRAB) in patients without concurrent bacteremia. Methods: This retrospective, multicenter study was conducted in 9 teaching hospitals in the Republic of Korea from May 2008 to April 2012. Study subjects included adult patients (aged ≥ 18 y) who yielded an MRAB-positive CVC tip culture without concurrent MRAB bacteremia. All patients were observed for the development of subsequent MRAB bacteremia for 6 months after CVC removal. Multivariable Firth logistic regression analysis was performed to determine predictors independently associated with subsequent MRAB bacteremia. Results: During the study period, subsequent MRAB bacteremia was observed in 18.8% of patients (21/112). Of the 112 patients, 23 (20.5%) did not show systemic inflammatory response syndrome (SIRS). None of the 23 patients without SIRS presented with subsequent MRAB bacteremia. Multivariable logistic regression analysis showed that prior administration of carbapenems (odds ratio (OR) 7.04, 95% confidence interval (CI) 1.43-34.77) or corticosteroids (OR 6.67, 95% CI 1.19-37.44), and C-reactive protein ≥ 40 mg/l (OR 18.11, 95% CI 2.22-148.07) were positive predictive factors. Prior acquisition of MRAB at a site other than the catheter (OR 0.10, 95% CI 0.03-0.39) was a negative predictive factor for developing MRAB bacteremia. Conclusions: Our results suggest that patients with a CVC tip colonized with MRAB should be closely monitored for signs and symptoms of subsequent MRAB bacteremia.

AB - Background: The purpose of this study was to examine the clinical implications of a positive central venous catheter (CVC) tip culture with multidrug-resistant Acinetobacter baumannii (MRAB) in patients without concurrent bacteremia. Methods: This retrospective, multicenter study was conducted in 9 teaching hospitals in the Republic of Korea from May 2008 to April 2012. Study subjects included adult patients (aged ≥ 18 y) who yielded an MRAB-positive CVC tip culture without concurrent MRAB bacteremia. All patients were observed for the development of subsequent MRAB bacteremia for 6 months after CVC removal. Multivariable Firth logistic regression analysis was performed to determine predictors independently associated with subsequent MRAB bacteremia. Results: During the study period, subsequent MRAB bacteremia was observed in 18.8% of patients (21/112). Of the 112 patients, 23 (20.5%) did not show systemic inflammatory response syndrome (SIRS). None of the 23 patients without SIRS presented with subsequent MRAB bacteremia. Multivariable logistic regression analysis showed that prior administration of carbapenems (odds ratio (OR) 7.04, 95% confidence interval (CI) 1.43-34.77) or corticosteroids (OR 6.67, 95% CI 1.19-37.44), and C-reactive protein ≥ 40 mg/l (OR 18.11, 95% CI 2.22-148.07) were positive predictive factors. Prior acquisition of MRAB at a site other than the catheter (OR 0.10, 95% CI 0.03-0.39) was a negative predictive factor for developing MRAB bacteremia. Conclusions: Our results suggest that patients with a CVC tip colonized with MRAB should be closely monitored for signs and symptoms of subsequent MRAB bacteremia.

KW - Acinetobacter baumannii

KW - Bacteremia

KW - Catheter-related infections

KW - Outcome

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