Risk factors for carbapenem non-susceptibility and mortality in Acinetobacter baumannii bacteremia in children

Objective: To examine the risk factors of carbapenem non-susceptibility and mortality among children with Acinetobacter baumannii bacteremia. Methods: A retrospective chart review was conducted of 180 cases with A. baumannii bacteremia. Results: The 30-day mortality risk of A. baumannii bacteremia was 26.1%. Carbapenem-non-susceptible A. baumannii was identified in 51.7% of cases. Logistic regression analysis indicated that prematurity, use of mechanical ventilation, and prior exposure to carbapenem antibiotics were independently associated with carbapenem-non-susceptible A. baumannii bacteremia, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of 3.36 (1.17-9.65), 5.59 (2.24-13.97), and 2.97 (1.01-8.77), respectively. Further, carbapenem non-susceptibility, cancer-related neutropenia, organ dysfunction, admission to the intensive care unit, catheter-related bacteremia, and treatment with sulbactam-containing regimens were associated with mortality with aORs and 95% CIs of 4.76 (1.58-14.32), 4.54 (1.09-18.79), 25.95 (5.13-131.33), 3.53 (1.29-9.71), 0.25 (0.084-0.72), and 0.14 (0.046-0.45), respectively. Conclusions: The majority of A. baumannii bacteremia was caused by carbapenem-non-susceptible strains with a high mortality rate. Carbapenem non-susceptibility, cancer-related neutropenia, the presence of organ dysfunction, and admission to an intensive care unit were associated with an increased mortality risk, whereas catheter-related bacteremia and treatment with a sulbactam-containing regimen were associated with decreased mortality among children with A. baumannii bacteremia. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.