Acinetobacter pneumonia: Is the outcome different from the pneumonias caused by other agents

Abstract

BACKGROUND:The principal aim of the present study was to determine whether Acinetobacter spp. pneumonia differs from hospital-acquired pneumonias (HAPs) caused by other agents with respect to therapeutic success and survival rate.METHODS:This study includes 140 adult patients diagnosed with HAPs caused by identified etiologic agents between March 2005 and February 2006. These patients were divided into two groups according to the agent responsible for their infection (Acinetobacter spp. [n = 63] or non-Acinetobacter spp. [n = 77]). The groups were compared in terms of risk factors, therapeutic success and six-week survival rates.RESULTS:Previous antibiotic use and the risk of aspiration were independent factors responsible for the development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp. pneumonia. The clinical success rate at the end of therapy was 41.6% and, at the sixth week, the survival rate was 35% among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the control group, these values were 43 and 32%, respectively (P > 0.05). We found that the use of the appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival (P < 0.001).CONCLUSION:The outcomes of Acinetobacter spp. pneumonia do not differ from HAPs associated with non-Acinetobacter spp. in terms of therapeutic success and survival rates.

Association between systemic corticosteroids and outcomes of intensive care unit–acquired pneumonia*

“…This finding is in line with previous observational studies that found lower survival in mixed critically-ill patients (12), sepsis (14,17), and influenza A H1N1 respiratory infection (32). In addition, our results confirm that corticosteroids are potentially harmful in less severely ill patients and in those at low risk of death (9,11,14,39,49).…”

“…Chronically exposed patients tended to show a poorer survival in an univariate analysis (hazard ratio 1.563, 95% confidence interval 0.940-2.599, p = .09) and similar secondary outcomes, except for shorter length of stay in the ICU (13 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] vs. 17 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], p = .050) when compared to acutely exposed patients. We therefore performed another sensitivity analysis on the subset of patients without chronic exposure to corticosteroids.…”

“…Several studies (7,(17)(18)(19)(20)(21) have evaluated the use of systemic corticosteroids during stay in the ICU with controversial results regarding response to treatment and mortality. Although the role of corticosteroids in preventing VAP in multiple trauma patients has been recently reported (16), no studies have comprehensively assessed the effects of systemic corticosteroids on the outcomes of patients with ICU-acquired pneumonia.…”

Evaluation of Risk and Prognostic Factors of Carbapenem Resistant Acinetobacter Baumannii Infections in Intensive Care Unit.

“…When the mortality-associated risk factors were evaluated by Edis et al, they reported that hypoalbuminemia, steroid use and the use of a mechanical ventilator increased mortality in A. baumannii pneumoniae [18]. If the patients did not receive appropriate antibiotic therapy, the mortality rate was reported to be 5-fold increased in this study.…”

Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing Klebsiella

“…As the days on mechanical ventilation raises, the incidence of this hospital acquired infection increases (The average is 5-7 days from the initiation of MV) [16]. In the previous studies, the most common causes of HAPs and VAPs were Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus, but recent studies have shown an increase in the prevalence of Klebsiella pneumoniae and Acinetobacter species [11,[17][18][19]. Resistance of AB and KP to Carbapenems is a challenging topic for the clinicians and infectious diseases control teams [11,20].…”