Carbapenem-Resistant <i>Acinetobacter baumannii</i> Infections Associated with Deep Venous Catheterization in Patients with Pulmonary Infection in the ICU

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an important cause of fatal drug-resistant infection in the intensive care unit (ICU). Thus, it is crucial to identify strategies to reduce the occurrence of CRAB infection. Although studies have revealed that CRAB is associated with invasive operations, little research has assessed the relationship between the occurrence of CRAB infections and different types of invasive procedures in patients with pulmonary infections in the ICU. Objectives: The present study explored the relationships between specific invasive procedures and CRAB infection to provide evidence for the clinical prevention and control of CRAB. Methods: This single-center retrospective analysis was conducted in the ICU and electronic ICU of Jiangsu Provincial Hospital of Traditional Chinese Medicine. Patients diagnosed with pulmonary infection caused by AB between June 2020 and December 2024 were enrolled. Patients were categorized according to the presence or absence of CRAB infection, and invasive operation types and mortality rates were compared between these groups. The factors affecting CRAB infection were analyzed by least absolute shrinkage and selection operator (LASSO) regression analysis. Patients were further divided into three groups based on the duration of deep venous catheterization, and the relationship between the risk of CRAB infection and the duration of catheterization was examined using multivariate regression models. Results: In total, 341 patients were included, with 216 patients in the CRAB group and 125 patients in the AB group. The 28-day all-cause mortality rate was higher in the CRAB group (52.8% vs. 38.4%; P < 0.001). Endotracheal intubation (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 3.81 - 13.92), chronic obstructive pulmonary disease (OR = 0.32, 95% CI = 0.14 - 0.77), a higher CURB-65 score (OR = 1.53, 95% CI = 1.16 - 2.02), and a longer duration of deep venous catheterization (6 - 10 days: OR = 2.39, 95% CI = 1.15 - 4.97; ≥ 10 days: OR = 10.56, 95% CI = 4.52 - 24.67) increased the risk for CRAB infection. In the fully adjusted model, the rate of CRAB infection was significantly higher in patients catheterized for 6 - 10 days (OR = 2.49, 95% CI = 1.16 - 5.34) or ≥ 10 days (OR = 12.63, 95% CI = 5.22 - 30.59). Conclusions: Tracheal intubation and prolonged deep venous catheterization in the ICU increased the risk of CRAB infection and reduced survival among patients with pulmonary infection. Thus, the duration of deep venous catheterization and the use of tracheal intubation in the ICU should be minimized to reduce the risk of CRAB infection.