A Comparison of Clinical Profile and Outcome among Critically Ill Patients with Hospital Acquired Infections Caused by Acinetobacter SPP Versus Other Bacterial Pathogens

PURPOSE: Acinetobacter species is being identified as a causative agent in increasingly larger proportion of hospital acquired infections (HAI). They are most commonly seen in an ICU setting, among critically ill patients. We attempted to answer the question of whether HAI caused by Acinetobacter species has poorer clinical outcomes when compared to HAI caused by other bacterial pathogens. OBJECTIVES: To compare the in-hospital mortality rates, duration of mechanical ventilation (assessed by duration of ventilator free days), duration of ICU stay and duration of hospital stay of patients with Hospital Acquired infections (HAI) caused by Acinetobacter spp. with HAI by other organisms. METHODS: This was a prospective cohort study among adult patients who developed a new fever 48 hours after admission in the Intensive Care Unit. If the patient fulfilled criteria for VAP or CR-BSI, then the patient was recruited into the study. The patients were followed up until death or discharge. The microbiological and clinical outcomes that were relevant were collected and analysed. RESULTS: 126 patients developed a HAI, during the course of the study period, of which 93 (73.8%) were VAP and 33 (26.1%) were CR-BSI, 77 (61%) developed Acinetobacter related HAI and 49 (39%) were Non-Acinetobacter related HAI. There were 44 deaths (57.1%) among the Acinetobacter group compared to 33 (42.9%) in the Non-Acinetobacter group but this difference was not statistically significant (CI- 0.935-3.99, p=0.074). 67 out of 93 cases of VAP (72%) were caused by Acinetobacter spp. The Acinetobacter group had more patients with 0 ventilator-free days (duration of mechanical ventilation >28 days or death) when compared to the Non-Acinetobacter group (45 patients, 57.2% vs 12 patients, 46.2%, p= 0.03). The duration of ICU stay and hospital stay was not significantly different between the two groups. CONCLUSIONS: In our cohort study of critically ill medical and surgical patients with VAP or CR-BSI, we found no significant increase in mortality rates among those with Acinetobacter related HAI’s compared to those with Non-Acinetobacter related HAI. However we found that the patients with Acinetobacter related HAI’s had significantly poorer ventilator outcomes (death or >28 days on Ventilator) but no significant increase in ICU or Hospital stay