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Article Dans Une Revue American Journal of Infection Control Année : 2019

Impact of an Acinetobacter baumannii outbreak on kidney events in a burn unit: A targeted machine learning analysis

Résumé

Background: Multidrug-resistant (MDR) bacteria outbreaks represent a major threat in intensive care units. Patients may then be exposed to drug-related direct toxicity during such outbreaks. The objective of this study was to explore the impact of an outbreak of imipenem-resistant Acinetobacter baumannii (IR-AB) on renal outcomes.Methods: We performed a before-and-after observational study in a French burn intensive care unit during an IR-AB outbreak: a 13-month period before (period A, October 2013-October 2014) and a 13-month period after outbreak control (period B, December 2014-December 2015). A total of 409 patients were included, 195 during period A and 214 during period B. The main endpoint was major adverse kidney events at day 90 (MAKE 90). Secondary endpoints were acute kidney injury (AKI) and persistent renal dysfunction.Results: Incidence of MAKE 90 was 15.9% during period A versus 11.2% during period B (P = .166) and AKI 28.2% versus 18.7% (P = .023). The use of colistin was associated with renal outcomes in univariate analysis. After adjustment of potential confounding factors using a targeted Machine Learning Analysis (ie, IR-AB-related infection, septic shock, severity scores, other nephrotoxics, chronic kidney disease, serum creatinine at admission, Staphylococcus aureus), colistin remained associated with the risk of MAKE and AKI (relative risk = 2.909, 95% confidence interval [CI] [1.364, 6.204], P = .006 for MAKE 90, and relative risk = 2.14, 95% CI [1.52, 3.02], P<.0001 for AKI).Conclusions: The episode of IR-AB outbreak was associated with an increased risk of kidney events, which appears to be driven by the use of colistin.

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Bactériologie
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hal-03127675 , version 1 (22-10-2021)

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Thomas Vauchel, Romain Pirracchio, Maïté Chaussard, Matthieu Lafaurie, Martine Rouveau, et al.. Impact of an Acinetobacter baumannii outbreak on kidney events in a burn unit: A targeted machine learning analysis. American Journal of Infection Control, 2019, 47 (4), pp.435-438. ⟨10.1016/j.ajic.2018.09.010⟩. ⟨hal-03127675⟩
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