Predictors of mortality in solid-organ transplant recipients with infections caused by Acinetobacter baumannii

Figures & data

Table 1 Demographic, laboratory, and clinical variables of 71 SOT patients with Acinetobacter baumannii infection

Characteristics	Value
Age, mean years ± SD	44.5±11.9
Male sex, n (%)	53 (74.6)
Temperature 39°C or greater, n (%)	17 (23.9)
Nosocomial origin, n (%)	64 (90.1)
Inappropriate antimicrobial use, n (%)	41 (57.7)
Induction therapy, n (%)	19 (26.8)
Acute rejection prior to infection, n (%)	13 (18.3)
High-dose steroids for rejection before infection, n (%)	8 (11.3)
Reoperation, n (%)	7 (9.9)
Carbapenem-resistant A. baumannii, n (%)	40 (56.3)
MDR A. baumannii, n (%)	53 (74.6)
ICU stay, n (%)	51 (71.8)
Mechanical ventilation, n (%)	33 (46.5)
Septic shock, n (%)	17 (23.9)
Type of transplantation, n (%)
Kidney	48 (67.6)
Liver	21 (29.6)
Liver–kidney	2 (2.8)
Site of infection, n (%)
Bloodstream	23 (32.4)
Lung	20 (28.2)
Intra-abdomen/biliary tract	8 (11.3)
Urinary tract	3 (4.2)
Vascular catheter	1 (1.4)
Multiple culture-positive sites	16 (22.5)
Patient immunosuppressant treatment, n (%)
Tacrolimus	62 (87.3)
Cyclosporine A	8 (11.3)
Time of infection onset, n (%)
<2 months posttransplant (early onset)	41 (57.7)
≥2 months posttransplant (late onset)	30 (42.3)
Laboratory variables from blood, n (%)
Platelet count <50,000/mm^3	24 (33.8)
Lymphocyte count <300/mm^3	23 (32.4)
Albumin <30 g/L	12 (16.9)
WBC count >15,000/mm^3	22 (31.0)
Creatinine >1.5 mg/dL	41 (57.7)
Related mortality, n (%)	29 (40.8)
Overall in-hospital mortality, n (%)	38 (53.5)

Abbreviations: SOT, solid-organ transplantation; SD, standard deviation; MDR, multidrug-resistant; ICU, intensive care unit; WBC, white blood cell.

Table 2 Risk factors for overall in-hospital mortality in SOT recipients with Acinetobacter baumannii infection

Characteristics	Overall mortality	Survival	P-value	OR (95% CI)
Total, n (%)	38 (53.5)	33 (46.5)
Univariate analysis, n (%)
Age ≥40 years	27 (71.1)	22 (66.7)	0.690	1.23 (0.45–3.36)
Male sex	26 (68.4)	27 (81.8)	0.200	0.48 (0.16–1.47)
Temperature ≥39°C	12 (31.6)	5 (15.2)	0.112	2.59 (0.80–8.34)
Inappropriate antibiotics	19 (50.0)	22 (66.7)	0.159	0.50 (0.19–1.31)
Nosocomial infection	35 (92.1)	29 (87.9)	0.554	1.61 (0.33–7.78)
Liver or liver–kidney transplant	17 (44.7)	6 (18.2)	0.020	3.64 (1.22–10.85)
Multiple culture-positive sites	11 (28.9)	5 (15.2)	0.171	2.28 (0.70–7.44)
Late-onset infection	20 (52.6)	10 (30.3)	0.060	2.56 (0.96–6.80)
Acute rejection	6 (15.8)	7 (21.2)	0.557	0.70 (0.21–2.33)
Induction therapy	8 (21.1)	11 (33.3)	0.531	0.71 (0.25–2.05)
Reoperation	5 (13.2)	2 (6.1)	0.328	2.35 (0.42–13.01)
MDR A. baumannii	29 (76.3)	24 (72.7)	0.729	1.21 (0.41–3.53)
ICU stay	35 (92.1)	16 (48.5)	<0.001	12.40 (3.17–48.42)
Mechanical ventilation	27 (71.1)	6 (18.2)	<0.001	11.04 (3.57–34.15)
Septic shock	15 (39.5)	2 (6.1)	0.004	10.11 (2.10–48.63)
Platelet count <50,000/mm^3	20 (52.6)	4 (12.1)	0.001	8.06 (2.37–27.40)
Lymphocyte count <300/mm^3	16 (42.1)	7 (21.2)	0.065	2.70 (0.94–7.75)
Albumin <30 g/L	10 (26.3)	2 (6.1)	0.036	5.54 (1.12–27.47)
WBC count ≥15,000/mm^3	10 (26.3)	12 (36.4)	0.690	0.82 (0.30–2.23)
Creatinine ≥1.5 mg/dL	26 (68.4)	15 (45.5)	0.053	2.60 (0.99–6.85)
Multivariate analysis
Liver or liver–kidney transplant			0.012	15.33 (1.82–129.18)
Late-onset infection			0.043	7.61 (1.07–54.36)
Mechanical ventilation			0.013	6.29 (1.48–26.85)

Abbreviations: SOT, solid-organ transplantation; OR, odds ratio; CI, confidence interval; MDR, multidrug-resistant; ICU, intensive care unit; WBC, white blood cell.

Table 3 Risk factors for infection-related mortality in SOT recipients with Acinetobacter baumannii infection

Characteristics	Related mortality	Survival	P-value	OR (95% CI)
Total, n (%)	29 (40.8)	42 (59.2)
Univariate analysis, n (%)
Age ≥40 years	20 (69.0)	29 (69.0)	0.994	0.99 (0.36–2.77)
Male sex	21 (72.4)	32 (76.2)	0.363	0.61 (0.21–1.78)
Temperature ≥39°C	11 (37.9)	6 (14.3)	0.026	3.67 (1.17–11.52)
Inappropriate antibiotics	15 (51.7)	26 (61.9)	0.394	0.66 (0.25–1.72)
Nosocomial infection	28 (96.6)	36 (87.9)	0.165	4.67 (0.53–41.03)
Liver or liver–kidney transplant	10 (34.5)	13 (31.0)	0.755	1.17 (0.43–3.21)
Multiple culture-positive sites	9 (31.0)	7 (16.7)	0.160	2.25 (0.73–6.97)
Late-onset infection	17 (58.6)	13 (31.0)	0.022	3.16 (1.18–8.48)
Acute rejection	6 (20.7)	7 (16.7)	0.667	1.30 (0.39–4.38)
Induction therapy	8 (27.6)	11 (26.2)	0.896	1.07 (0.37–3.12)
Reoperation	3 (10.3)	4 (9.5)	0.909	1.10 (0.23–5.31)
MDR A. baumannii	24 (82.8)	29 (69.0)	0.197	2.15 (0.67–6.90)
ICU stay	28 (96.6)	23 (54.8)	0.003	23.13 (2.88–186.10)
Mechanical ventilation	26 (89.7)	7 (16.7)	<0.001	43.33 (10.22–183.73)
Septic shock	14 (48.3)	3 (7.1)	<0.001	12.13 (3.05–48.32)
Platelet count <50,000/mm^3	16 (55.2)	8 (19.0)	0.002	5.23 (1.81–15.14)
Lymphocyte count <300/mm^3	13 (44.8)	10 (23.8)	0.066	2.60 (0.94–7.21)
Albumin <30 g/L	8 (27.6)	4 (9.5)	0.055	3.62 (0.97–13.46)
WBC count >15,000/mm^3	9 (31.0)	13 (31.0)	0.994	1.00 (0.36–2.79)
Creatinine >1.5 mg/dL	21 (72.4)	20 (47.6)	0.041	2.89 (1.05–7.97)
Multivariate analysis
Mechanical ventilation			,0.001	189.98 (13.23–2,728.81)
Platelet count <50,000/mm^3			0.030	12.76 (1.28–126.81)

Abbreviations: SOT, solid-organ transplantation; OR, odds ratio; CI, confidence interval; MDR, multidrug-resistant; ICU, intensive care unit; WBC, white blood cell.