270. Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia

Abstract Background Viridans group streptococci (VGS) is an infrequent yet significant cause of bloodstream infections, and complicated cases may require prolonged antibiotic therapy. Ceftriaxone (CTX) and penicillin G (PCN G) are both considered first line options for VGS infections, but comparisons between these agents are limited. We evaluated the clinical outcomes amongst patients treated with CTX and PCN G for complicated VGS bacteremia. Methods This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN G arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS or an adverse event (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to an antibiotic-related AE, and development of extended-spectrum beta lactamase resistance. Secondary outcomes included the individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened for inclusion, 94 patients met eligibility criteria (CTX n= 64, PCN G n=34). Median age was 68 years (IQR 56–81) and 68% were male. Study patients did not present with critical illness, as reflected by a median Pitt bacteremia score of 0 in the CTX and 1 in the PCN G arms, P=0.764. Streptococcus mitis was the most common VGS isolate and infective endocarditis (IE) was the predominant source of infection. CTX was not significantly associated with increased risk of the primary outcome (14% vs. 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. Results were similar in the subgroup of patients with IE (12.5% vs. 23.5%). No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary outcome (OR 0.1; 95% CI 0.020–0.6771; P= 0.017). Conclusion Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate a higher rate of treatment failure, adverse events, or resistance. These findings warrant further exploration. Disclosures All Authors: No reported disclosures

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Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa542 ◽

2020 ◽

Author(s):

Stephanie Wo ◽

Yanina Dubrovskaya ◽

Justin Siegfried ◽

John Papadopoulos ◽

Shin-Pung Jen

Keyword(s):

Adverse Events ◽

Clinical Outcomes ◽

Hospital Readmission ◽

Protective Factor ◽

Bloodstream Infections ◽

Penicillin G ◽

Eligibility Criteria ◽

Safety Outcome ◽

Increased Risk ◽

Viridans Group Streptococci

Abstract Background Ceftriaxone (CTX) and penicillin G (PCN G) are considered reasonable treatment options for viridans group streptococci (VGS) bloodstream infections, but comparisons between these agents are limited. We evaluated clinical outcomes amongst patients treated with these agents for complicated VGS bacteremia. Methods This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS bacteremia or adverse events (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to AE from therapy, and development of extended-spectrum beta-lactamase resistance. Secondary outcomes included individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened, 94 met eligibility criteria (CTX n= 64, PCN n=30). Streptococcus mitis was the most common isolate and infective endocarditis was the predominant source of infection. CTX was not significantly associated with increased risk of the primary composite safety outcome (CTX 14% vs. PCN 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary composite safety outcome. Conclusions Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate higher rates of treatment failure, adverse events, or resistance.

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195. Duration of Therapy for Streptococcal Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.397 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S205-S205

Author(s):

John M Boulos ◽

Valeria Fabre ◽

Kate Dzintars ◽

George Jones ◽

...

Keyword(s):

Antibiotic Therapy ◽

Clinical Outcomes ◽

Hospital Readmission ◽

Primary Outcome ◽

Bloodstream Infections ◽

Multivariable Logistic Regression Analysis ◽

Eligibility Criteria ◽

Short Course ◽

All Cause Mortality ◽

Long Course

Abstract Background Shorter durations have shown similar clinical outcomes as longer durations for uncomplicated (source-controlled) Gram-negative bloodstream infections (BSI). There is limited data on the outcomes of patients with non-pneumococcal streptococcal BSI receiving shorter durations of therapy compared to usual durations. Methods This was a retrospective, multicenter study of adults hospitalized between January 2018 and March 2019 with ≥ 1 blood culture positive for Streptococcus spp. Exposed patients were those who received ≤ 10 days of antibiotics (i.e., short course therapy) and unexposed patients were those who received 11-21 days of antibiotics (i.e., prolonged course therapy). Patients were excluded if they had S. pneumoniae BSI, suspected contamination, did not receive or complete therapy, or treated for > 21 days. The primary outcome was a composite of recurrent bacteremia with the same pathogen, hospital readmission, or all-cause mortality, all within 30 days from completing therapy. The odds of achieving the primary outcome was compared between exposed and unexposed patients using multivariable logistic regression analysis. Results A total of 176 patients met eligibility criteria. 35 (20%) received a short course (median 8 days) and 141 (80%) received a prolonged course (median 15 days) of antibiotic therapy. Baseline characteristics were similar between short and long course groups. The most common pathogens were viridans group streptococci (22%) and S. agalactiae (23%). The most common BSI source was skin and soft tissue infection (SSTI) (40%). The primary outcome occurred in 26% (9/35) and 23% (33/141) of patients in the short course and prolonged course groups, respectively (p = 0.774). The proportion of patients in the short course and prolonged course groups who experienced recurrent BSI, hospital readmission, or all-cause mortality were also non-significant. After adjusting for receipt of an infectious diseases consult, Pitt bacteremia score, and SSTI source, the adjusted odds of meeting the composite outcome remained unchanged (aOR 1.41, 95% CI 0.55 – 3.61, p = 0.466). Table 1. Cohort Characteristics Table 2. Source/Microbiology Table 3. Outcomes Conclusion Approximately a week of antibiotic therapy may be associated with similar clinical outcomes as longer antibiotics courses in patients with uncomplicated streptococcal BSI. Disclosures Kate Dzintars, PharmD, Nothing to disclose Sara E. Cosgrove, MD, MS, Basilea (Individual(s) Involved: Self): Consultant Pranita Tamma, MD, MHS, Nothing to disclose

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Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

Frontiers in Neurology ◽

10.3389/fneur.2021.668363 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zongjie Shi ◽

Shunyuan Guo ◽

Jie Pan ◽

Chao Xu ◽

Yu Geng ◽

...

Keyword(s):

Clinical Outcomes ◽

Primary Outcome ◽

Mechanical Thrombectomy ◽

Fasting Glucose ◽

Independent Predictor ◽

Secondary Outcome ◽

Vessel Occlusion ◽

Glucose Levels ◽

Increased Risk ◽

Symptomatic Intracranial Hemorrhage

Background and objective: Hyperglycemia on admission was associated with worse clinical outcomes after mechanical thrombectomy (MT) of acute ischemic stroke (AIS). We evaluated whether increased postoperative fasting glucose (PFG) was also related to poor clinical outcomes in patients who underwent MT treatment.Methods: Consecutive patients with large vessel occlusion underwent MT in our center were included. Admission glucose and fasting glucose levels after MT treatment were evaluated. Primary outcome was 90-day unfavorable outcomes (modified Rankin Scale score of 3–6). Secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH) after MT treatment. The association of PFG and 90-day clinical outcome after MT treatment was determined using logistic regression analyses.Results: One hundred twenty seven patients were collected. The median postoperative fasting glucose level was 6.27 mmol/L (IQR 5.59–7.62). Fourteen patients (11.02%) had sICH, and fifty-eight patients (45.67%) had unfavorable outcomes at 90-day after MT. After adjustment for potential confounding factors, PFG level was an independent predictor of 90-day unfavorable outcome (OR 1.265; 95% CI 1.017–1.575; p = 0.035) and sICH (OR 1.523; 95% CI 1.056–2.195; p = 0.024) after MT. In addition, older age, higher baseline NIHSS score, and higher postoperative NLR were also associated with unfavorable outcomes at 90-day after MT treatment.Conclusions: Increased PFG is associated with unfavorable outcomes at 90-day and an increased risk of sICH in patients underwent MT treatment.

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Abstract WP35: Outcomes of Mechanical Embolectomy in Patients Treated Beyond 8 hours From Stroke Onset: a Subanalysis of the North American SOLITAIRE Stent-retriever Acute Stroke Registry

Stroke ◽

10.1161/str.47.suppl_1.wp35 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Alex Abou-Chebl ◽

Alicia Castonguay ◽

Franklin A Marden ◽

Raul G Nogueira ◽

Robin Novakovic ◽

...

Keyword(s):

Clinical Outcomes ◽

Primary Outcome ◽

Stroke Onset ◽

Anterior Circulation ◽

Stroke Registry ◽

The North ◽

Primary Endpoints ◽

Increased Risk ◽

Stent Retrievers ◽

Baseline Demographic

Background and Purpose: Endovascular therapy (EVT) with stent-retrievers is safe and effective within 6-8hours of acute ischemic stroke onset; however a large proportion of patients present beyond 8hrs. There is a paucity of data on the safety and effectiveness of EVT in this latter population. Methods: We reviewed demographic, clinical, procedural and clinical outcomes data from consecutive patients treated with the Solitaire™ FR device in the investigator-initiated NASA Registry. Patients were divided into early (≤8hrs) and late (>8hrs) presenting groups. Primary outcomes (90-day mRS 0-2, mortality, and symptomatic ICH) were compared. Results: Three hundred and fifty-four patients from 24 centers were enrolled in NASA. Sixty-three (18%) patients presented >8hrs from onset and were treated. Baseline demographic and procedural factors were comparable between the early and late groups, except for time-to-treatment (271.9±97.3min vs. 754±269.3min, p<0.0001), IV tPA utilization (52.6% vs. 11.1%, <0.0001), baseline diastolic BP (77.9±16.8mmHg vs. 83.8±20.2mmHg, p=0.03), and frequency of vertebrobasilar occlusions (7.1% vs. 19.1%, p=0.0034). Procedural aspects were similar except for time to recanalization (early 73.8±84.5min vs. late 53.6±32min, p=0.0074). Recanalization success (TICI≥2b) was comparable (early 74.4% vs. late 76.2%, p=0.76). The primary outcome measures including symptomatic ICH (11.6% vs. 4.8%, p=0.11), mortality (29.9% vs. 29.3%, p=0.93), and mRS 0-2 (44.4% vs. 34.5%, p=0.17) were similar between the early and late groups, respectively. When only anterior circulation strokes were included (N=301), the data did not change significantly and the primary endpoints of symptomatic ICH (12.1% vs. 5.9%, p=0.2), mortality (27.9% vs. 27.7%, p=0.97) and mRS 0-2 (44.6% vs. 36.2%, p=0.29) remained comparable between the early and late groups, respectively. Conclusions: The NASA Registry has demonstrated that clinical outcomes of patients treated >8hrs from stroke onset are favorable and comparable to the outcomes of patients treated earlier. Later treatment in these selected patients was not associated with an increased risk of symptomatic ICH. Future trials should prospectively evaluate the benefit of EVT beyond 8hrs.

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Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke

Neurology ◽

10.1212/wnl.0000000000008389 ◽

2019 ◽

Vol 93 (18) ◽

pp. e1675-e1685 ◽

Cited By ~ 4

Author(s):

Chongke Zhong ◽

Guangli Wang ◽

Tan Xu ◽

Zhengbao Zhu ◽

Daoxia Guo ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Scale Score ◽

Primary Outcome ◽

Tissue Inhibitor ◽

Vascular Events ◽

Baseline Serum ◽

Hazard Ratios ◽

Increased Risk

ObjectiveTo prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke.MethodsWe derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.ResultsA total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06–1.29) for the primary outcome, 1.13 (1.02–1.25) for major disability, 1.49 (1.19–1.87) for death, and 1.34 (1.11–1.62) for the composite outcome of death and vascular events. The addition of serum TIMP-1 to conventional risk factors model significantly improved risk prediction of the primary outcome (net reclassification index 9.0%, p = 0.02; integrated discrimination improvement 0.2%, p = 0.03). Participants with both higher TIMP-1 and matrix metalloproteinase-9 levels simultaneously had the highest risk of all study outcomes.ConclusionsHigher TIMP-1 levels were associated with increased risk of mortality and major disability after acute ischemic stroke. Our findings provided evidence supporting the important prognostic role of extracellular matrix biomarkers after acute ischemic stroke.

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Serum potassium as a predictor of adverse clinical outcomes in patients with increasing comorbidity burden

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcaa078 ◽

2020 ◽

Author(s):

Eskinder Tafesse ◽

Michael Hurst ◽

Daniel Sugrue ◽

Louise Hoskin ◽

Karolina Badora ◽

...

Keyword(s):

Clinical Outcomes ◽

Chronic Kidney Disease Stage ◽

Electrolyte Imbalance ◽

Disease Stage ◽

Major Adverse Cardiovascular Events ◽

Clear Correlation ◽

Eligibility Criteria ◽

Increased Risk ◽

Comorbidity Burden ◽

Life Threatening

Abstract Aims The aim of this study was to establish whether patients with multiple comorbidities may be at elevated risk of hyperkalaemia (HK), a potentially life-threatening electrolyte imbalance, and the associated adverse clinical outcomes. Methods and results This was a retrospective, observational cohort study using UK primary and secondary care data. Adult patients with at least one of: resistant hypertension, chronic kidney disease stage 3+, dialysis, heart failure (HF), and diabetes, were eligible for inclusion. According to their diagnoses, patients were grouped into overlapping cohorts that were updated as multimorbidity progressed. Outcomes of interest were incident HK, all-cause mortality (ACM), and major adverse cardiovascular events (MACE). A total of 673 686 patients met the eligibility criteria, 36.3% of whom developed multimorbidity during the study period. A consistent U-shaped association was observed between serum K+ level and adjusted incidence of ACM and MACE. Hyperkalaemia was progressively more common with increasing Charlson Comorbidity Index (CCI). Relative to a CCI <3, scores of ≥3 to <6, and ≥6 were associated with 2.9- and 6.2-fold increases, respectively, in crude HK (serum K+ ≥5.0 mmol/L) incidence rate. In all condition-based cohorts except for HF, there was a clear correlation between increasing CCI and the risk of ACM and MACE associated with hypokalaemia and HK. Conclusion Patients with a higher CCI are at an increased risk of developing HK and appear more prone to adverse clinical outcomes associated with abnormal serum K+ levels, warranting additional routine clinical monitoring.

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Plasma S100A8/A9 Concentrations and Clinical Outcomes of Ischemic Stroke in 2 Independent Multicenter Cohorts

Clinical Chemistry ◽

10.1093/clinchem/hvaa069 ◽

2020 ◽

Vol 66 (5) ◽

pp. 706-717

Author(s):

Daoxia Guo ◽

Zhengbao Zhu ◽

Tan Xu ◽

Chongke Zhong ◽

Aili Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Primary Outcome ◽

High Plasma ◽

Secondary Outcome ◽

Composite Outcome ◽

Vascular Events ◽

Hazard Ratios ◽

Increased Risk

Abstract Background S100A8/A9 is implicated in inflammation mechanisms related to atherosclerosis and plaque vulnerability, but it remains unclear whether S100A8/A9 is associated with the prognosis of ischemic stroke. The aim of this study was to investigate these associations in 2 independent multicenter cohorts. Methods Plasma S100A8/A9 concentrations at baseline were measured among 4785 patients with ischemic stroke from 2 independent cohorts: Infectious Factors, Inflammatory Markers, and Prognosis of Acute Ischemic Stroke (IIPAIS) and China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a composite outcome of death or major disability at 3 months after ischemic stroke. Secondary outcomes were major disability, death, and a composite outcome of death or vascular events. Results Among the combined participants of IIPAIS and CATIS, the adjusted odds ratios associated with the highest quartile of plasma S100A8/A9 were 2.11 (95% CI, 1.66–2.68) for the primary outcome and 1.62 (95% CI, 1.27–2.07) for the secondary outcome of major disability; adjusted hazard ratios were 4.14 (95% CI, 2.10–8.15) for the secondary outcome of death and 2.08 (95% CI, 1.38–3.13) for the composite outcome of death or vascular events. Each SD increase of log-transformed S100A8/A9 was associated with 28% (95% CI, 18%–39%; P < 0.001) increased risk of the primary outcome. Multivariable-adjusted spline regression analyses showed a linear association between plasma S100A8/A9 concentrations and primary outcome (P < 0.001 for linearity). Subgroup analyses further confirmed these associations. Conclusions High plasma S100A8/A9 concentrations at baseline were independently associated with increased risks of adverse clinical outcomes at 3 months after ischemic stroke, suggesting that S100A8/A9 might have a role as a prognostic marker of ischemic stroke.

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Fluoroquinolone Versus Nonfluoroquinolone Treatment of Bloodstream Infections Caused by Chromosomally Mediated AmpC-Producing Enterobacteriaceae

Antibiotics ◽

10.3390/antibiotics9060331 ◽

2020 ◽

Vol 9 (6) ◽

pp. 331

Author(s):

Sarah Grace Gunter ◽

Katie E. Barber ◽

Jamie L. Wagner ◽

Kayla R. Stover

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Primary Outcome ◽

Bloodstream Infections ◽

Clinical Failure ◽

Beta Lactam ◽

Definitive Therapy ◽

Effective Option ◽

Secondary Endpoints ◽

Microbiological Cure

Objectives: Chromosomally mediated AmpC-producing Enterobacteriaceae (CAE) display high susceptibility to fluoroquinolones; minimal clinical data exist supporting comparative clinical outcomes. The objective of this study was to compare treatment outcomes between fluoroquinolone and nonfluoroquinolone definitive therapy of bloodstream infections caused by CAE. Methods: This retrospective cohort assessed adult patients with positive blood cultures for CAE that received inpatient treatment for ≥48 h. The primary outcome was difference in clinical failure between patients who received fluoroquinolone (FQ) versus non-FQ treatment. Secondary endpoints included microbiological cure, infection-related length of stay, 90-day readmission, and all-cause inpatient mortality. Results: 56 patients were included in the study (31 (55%) received a FQ as definitive therapy; 25 (45%) received non-FQ). All non-FQ patients received a beta-lactam (BL). Clinical failure occurred in 10 (18%) patients, with 4 (13%) in the FQ group and 6 (24%) in the BL group (p = 0.315). Microbiological cure occurred in 55 (98%) patients. Median infection-related length of stay was 10 (6–20) days, with a significantly longer stay occurring in the BL group (p = 0.002). There was no statistical difference in 90-day readmissions between groups (7% FQ vs. 17% BL; p = 0.387); one patient expired. Conclusion: These results suggest that fluoroquinolones do not adversely impact clinical outcomes in patients with CAE. When alternatives to beta-lactam therapy are needed, fluoroquinolones may provide an effective option.

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Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

Journal of Clinical Medicine ◽

10.3390/jcm10173947 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3947

Author(s):

Savanna SanFilippo ◽

Veronique Michaud ◽

Juanqin Wei ◽

Ravil Bikmetov ◽

Jacques Turgeon ◽

...

Keyword(s):

Risk Score ◽

Hospital Readmission ◽

Readmission Rate ◽

Primary Outcome ◽

Elderly Care ◽

The Elderly ◽

Secondary Outcome ◽

Medication Regimen ◽

Increased Risk ◽

Medication Risk

Existing risk tools that identify patients at high risk of medication-related iatrogenesis are not sufficient to holistically evaluate a patient’s entire medication regimen. This study used a novel medication risk score (MRS) which holistically evaluates medication regimens and provides actionable solutions. The main purpose of this study was to quantify adults ≥ 65 years with a high medication risk burden using the MRS and secondarily, appraise MRS association with hospital readmission. This retrospective cohort study included all consecutive patients in a 6-month period aged 65 years and older, admitted for at least 48 h, and prescribed at least five medications upon discharge. Out of 3017 patients screened, 1386 met all criteria. The primary outcome was the proportion of patients with a score of ≥20 and the secondary outcome was the 30-day readmission rate. In the overall population, 17% of patients had an MRS ≥ 20. For patients discharged home, there was a 19% readmission rate for a score ≥ 20 and 11% for <20 (p = 0.009). A score of ;≥20 was associated with a 1.8-fold increased risk of readmission in patients discharged home. Only 7% of patients met these criteria, which can help direct future use of the MRS at patients with the highest risk of medication-related iatrogenesis.

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Epidemiology of Bloodstream Infections Caused by Acinetobacter baumannii and Impact of Drug Resistance to both Carbapenems and Ampicillin-Sulbactam on Clinical Outcomes

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01520-13 ◽

2013 ◽

Vol 57 (12) ◽

pp. 6270-6275 ◽

Cited By ~ 27

Author(s):

Teena Chopra ◽

Dror Marchaim ◽

Reda A. Awali ◽

Amar Krishna ◽

Paul Johnson ◽

...

Keyword(s):

Hospital Mortality ◽

Acinetobacter Baumannii ◽

Clinical Outcomes ◽

Medical Records ◽

Independent Predictor ◽

Medical Center ◽

Bloodstream Infections ◽

Content Type ◽

Increased Risk ◽

Prior Use

ABSTRACTAcinetobacter baumanniihas become a leading cause of bloodstream infections (BSI) in health care settings. Although the incidence of infection with carbapenem- and ampicillin-sulbactam-resistant (CASR)A. baumanniihas increased, there is a scarcity of studies which investigate BSI caused by CASRA. baumannii. A retrospective cohort study was conducted on adult patients with BSI caused byA. baumanniiand who were admitted to the Detroit Medical Center between January 2006 and April 2009. Medical records were queried for patients' demographics, antimicrobial exposures, comorbidities, hospital stay, and clinical outcomes. Bivariate analyses and logistic regression were employed in the study. Two hundred seventy-four patients with BSI caused byA. baumanniiwere included in the study: 68 (25%) caused by CASRA. baumanniiand 206 (75%) caused by non-CASRA. baumannii. In multivariate analysis, factors associated with BSI caused by CASRA. baumanniiincluded admission with a rapidly fatal condition (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.27 to 6.32,Pvalue = 0.01) and prior use of antimicrobials (OR = 2.83, 95% CI = 1.18 to 6.78,Pvalue = 0.02). In-hospital mortality rates for BSI caused by CASRA. baumanniiwere significantly higher than those for non-CASRA. baumannii-induced BSI (43% versus 20%; OR = 3.0, 95% CI = 1.60 to 5.23,Pvalue < 0.001). However, after adjusting for potential confounders, the association between BSI caused by CASRA. baumanniiand increased risk of in-hospital mortality was not significant (OR = 1.15, 95% CI = 0.51 to 2.63,Pvalue = 0.74). This study demonstrated that CASRA. baumanniihad a distinct epidemiology compared to more susceptibleA. baumanniistrains; however, clinical outcomes were similar for the two groups. Admission with a rapidly fatal condition was an independent predictor for both CASRA. baumanniiand in-hospital mortality.

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