Risk Factors Associated with Recurrent Pregnancy Loss Observed in Women Who Delivered a Growth-Restricted Infant

To determine the risk factors associated with mortality in Acinetobacter calcoaceticus–baumannii (Acb) complex blood stream infection.This was an observational study conducted in tertiary care hospital of South India. All patients with blood culture positive for Acb complex from January 2008 to December 2009 were included and a standardized abstraction form was used to abstract data. P value was calculated by Chi square test. Univariate analysis was done by using 2×2 tables and the variables with P value of <0.1 were further subjected to multivariate analysis. Multivariate analysis was done by logistic regression method.After excluding the polymicrobial infections and duplicate isolates from the same patients, 81 cases were included in our study. Out of 81 patients, 20 (24.6%) patients had positive isolate from body secretion other than blood for Acb complex, majority were hospitalized in intensive care unit (74%), had indwelling vascular catheters (68%) and were mechanically ventilated (61%). Multi drug resistant phenotypes were seen in 56 (69.1%) isolates and among them 13 (16%) were resistant to carbapenems. Univariate analysis showed renal disease, diabetes mellitus, use of mechanical ventilation and absence of appropriate antibiotic therapy, leucopenia, thrombocytopenia and raised prothrombin time were related to increased mortality in Acb complex bacteraemia. However, in multivariate analysis independent risk factors for mortality in Acb complex bacteraemia were platelets of less than 1.5 lacks and inappropriate empirical antibiotics.Thrombocytopenia and absence of appropriate antibiotics were risk factors associated with mortality in Acb bacteraemia. Patients with blood culture showing Acb complex bacteraemia with above findings should be attended with aggressive management. Clinician of hospitals with high incidence of Acb complex bacteraemia, should predict the chances of such infection even prior to blood culture reports are available, and should initiate appropriate antibiotics according to their institution antibiogram.