Retrospective analysis of Acinetobacter baumannii bacteraemia risk factors, complications, and mortality in a tertiary university hospital in Saudi Arabia

  1. Reham Kaki

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Abstract

Introduction. There are many multidrug-resistant isolates of the nosocomial pathogen, Acinetobacter baumannii causing severe healthcare-acquired infections in terminally ill patients with high mortality and morbidity rates.   Aim. This study aimed to retrospectively analyse Acinetobacter baumannii bacteraemia (ABB) cases in Saudi Arabia where the information is sparse regarding the prevalence, risk factors, clinical disease, antibiotic regimen, antibiotic susceptibility, treatment outcomes, and mortality associated with this infection.   Methods.  A retrospective chart review was conducted between January 1st, 2015, and December 31st, 2022, to identify all patients 14 years and above with ABB. Demographic and clinical data, as well as results from laboratory analyses, were collected from patients’ electronic charts. Statistical analyses were performed on the data to identify factors associated with 90-day mortality.   Results. Of the 122 ABB cases, 71 (63.4%) died. The factors that were found to be associated with 90-day mortality were the Charlson comorbidity score, Pitt bacteremia score, quick Sequential Organ Failure Assessment (qSOFA) score (p < 0.001 for each), hospital ward (p < 0.02), short duration of antibiotic treatment (p < 0.01), and higher age (p < 0.05). The most common source of infection was Central Line-associated Bloodstream Infection in 52.7%. Also associated with mortality were inappropriate antimicrobial therapy (p < 0.02) and empirical use of colistin (p < 0.05). In many patients, ABB was caused by carbapenem-resistant A. baumannii (CRAB) (69.6%), and 74.4% of those patients died.   Conclusion. To prevent ABB-associated mortality, an appropriate regimen and duration of treatment are necessary. Hospitals should also practice proper hygiene to prevent the spread of ABB. CRAB is a growing threat in hospitals in Saudi Arabia especially in the critical care setting and carries a very high risk of mortality.

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  2. Version published to 10.1099/acmi.0.000826.v3 on Access Microbiology
  3. Version published to 10.1099/acmi.0.000826.v4 on Access Microbiology
  5. Version published to 10.1099/acmi.0.000826.v2 on Access Microbiology
  6. Access Microbiology

    Both reviewers have mentioned the lack of connection between your stated aims and the conclusions drawn- please pay close attention to this during your revisions. Please respond to each reviewer comment point by point.

  7. Access Microbiology

    Comments to Author

    Title and Abstract Line 20-21: The abstract should provide a brief background, methods, results, and conclusion. Consider rephrasing to make it more concise and focused. Introduction Line 56-57: Clarify the significance of the pathogen in the hospital setting. Line 70-73: Provide more context on the high mortality rates mentioned by citing specific studies or reports. Methods Line 95-97: Specify the criteria used to identify Acinetobacter-positive blood cultures. Line 104: Provide more details on the ethical review process and how patient confidentiality was maintained. Line 115-124: The process for identifying and testing Acinetobacter isolates could be detailed further to enhance replicability. Line 131-136: Clarify the statistical methods used, especially how the confidence intervals and p-values were determined. Results Line 138-139: Include more demographic details to give a fuller picture of the study population. Line 147-149: Explain why only the location variable was significantly associated with mortality. Line 157: Specify the statistical significance of higher age and lower antibiotic duration more clearly. Line 163-164: Provide more details on the clinical signs and symptoms to better understand their relevance. Line 170-173: Explain the significance of the p-values for comorbidities and risk factors. Discussion Line 221-223: Summarize the key findings more clearly and relate them back to the study objectives. Line 228-229: Expand on why the high mortality rates for CRAB are not surprising. Line 238-240: Discuss the implications of the study findings in the context of other similar studies. Line 269-273: Elaborate on the choice of antibiotics used and how this aligns with current treatment guidelines.

    Please rate the manuscript for methodological rigour

    Satisfactory

    Please rate the quality of the presentation and structure of the manuscript

    Satisfactory

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  9. Version published to 10.1099/acmi.0.000826.v1 on Access Microbiology