Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2015; 4(3): 258-264
Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.258
Outcomes of critically ill cancer patients with Acinetobacter baumannii infection
Silvio A Ñamendys-Silva, Paulina Correa-García, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Patricia Cornejo-Juárez, Abelardo Meneses-García
Silvio A Ñamendys-Silva, Francisco J García-Guillén, María O González-Herrera, Américo Pérez-Alonso, Julia Texcocano-Becerra, Angel Herrera-Gómez, Abelardo Meneses-García, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
Silvio A Ñamendys-Silva, Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico
Paulina Correa-García, Division of Education and Research, Hospital de la Mujer, Mexico City 11340, Mexico
Patricia Cornejo-Juárez, Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: This investigation was approved by the Scientific and Ethics Committees at INCan, and the requirement for informed consent was waived (Rev/02/13). A copy of approval can be provided on request.
Informed consent statement: This study has been approved by the Bioethics Committee of INCan, and the requirement for informed consent was waived.
Conflict-of-interest statement: None of the authors have commercial association or financial involvement that might pose a conflict of interest in connection with this article.
Data sharing statement: Data presented in the manuscript is anonymised and the risk of identifying individual patient is very low. No additional data is available other than stated in the manuscript for this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Silvio A Ñamendys-Silva, MD, MSc, FCCP, Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico. Av. San Fernando No. 22, Col. Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico.snamendys@incan.edu.mx
Telephone: +52-55-47471020
Received: February 12, 2015
Peer-review started: February 14, 2015
First decision: March 20, 2015
Revised: April 30, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: August 4, 2015
Abstract

AIM: To describe the intensive care unit (ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii (AB) infection.

METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico (INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.

RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23 (4.6%) of whom developed AB infections. Sixteen (60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock (56.2%) and postoperative care (21.7%). The respiratory tract was the most frequent site of AB infection (91.3%). The most common organ dysfunction observed in our group of patients were the respiratory (100%), cardiovascular (100%), hepatic (73.9%) and renal dysfunction (65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7% (2/17) compared with 66.6% (4/6) for the group of patients with 4 or more organ system dysfunctions (P = 0.021). Multivariate analysis identified blood lactate levels (BLL) as the only variable independently associated with in-ICU death (OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.

CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.

Keywords: Outcomes, Cancer patients, Acinetobacter baumannii, Intensive care, Critical care

Core tip: Several factors have been associated with poor prognosis among critically ill patients with infections caused by Acinetobacter baumannii (AB) in the intensive care unit (ICU) including renal failure, thrombocytopenia, neutropenia, history of prior immunosuppressive therapy use, the need for invasive mechanical ventilation, and development of severe sepsis. In this study the mortality rate in patients with both hematological malignancies, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a blood lactate levels ≥ 2.6 mmol/L in the first day of stay in the ICU.