Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Abstract

Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017-0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028-0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.

Analysis of applied empirical treatments against VAP caused by Acinetobacter baumannii

“…Spostrzeżenia te pokrywają się z danymi z piśmiennictwa, które wskazują, że u chorych z grup ryzyka, m.in. : poprzednio hospitalizowanych, poddanych wcześniejszej antybiotykoterapii [8], zabiegom operacyjnym, w podeszłym wieku, z przewlekłymi chorobami układu oddechowego, z chorobami układu krążenia, chorobami metabolicznymi, niewydolnością nerek, wątroby, występuje częstsze ryzyko izolacji drobnoustrojów lekoopornych [12,13], a poziom występowania zgonów sięga 61% [5] lub nawet 70% [4]. W niniejszej pracy ustalono, że zastosowane leczenie empiryczne chorych z VAP różniło się od zalecanych rekomendacji.…”

“…Dodatkowo minimalne wymagania odżywcze, zdolność A. baumannii do długiego przetrwania w środowi-sku szpitalnym oraz naturalna oporność na wiele chemioterapeutyków sprawia, że celem tej bakterii są najczęściej chorzy z obniżoną odpornością. Drobnoustrój ten jest odpowiedzialny za ok. 5-10% przypadków VAP występujących w OIT i wiąże się z wysokim odsetkiem śmiertelności (61%) [5]. …”

Epidemiology and Mortality Predictors for Severe Childhood Pneumonia in ICUs: A Real-World Study in China

“…In addition, current limited randomized controlled trials (RCT) have revealed that several medications utilized in childhood pneumonia are signi cantly associated with clinical outcome. For instance, ambroxol, probiotics and bronchodilators are considered as protective factors for mortality in critically ill children [15][16][17][18][19] . Furthermore, Smit et al sedative-hypnotics could signi cantly increase the mortality of children with pneumonia 20 .…”

Expression of Toll-like receptor 4 in lungs of immune-suppressed rat with Acinetobacter baumannii infection

“…In recent years, Acinetobacter baumannii ( A. baumannii ) has become a major nosocomial pathogen and frequent cause of hospital-acquired pneumonia, surgical wound infections and sepsis ( 1 – 3 ). The mortality of A. baumannii -VAP cases in critical care units is 42% ( 2 ), rendering A. baumannii a serious threat to ICU populations.…”

“…Clinically, patients with low immune function are particularly prone to A. baumannii infection, although the reason for this susceptibility remains to be determined. In ICU patients, because of the high prevalence of A. baumannii drug resistance, most A. baumannii infections result in severe bacterial infection, respiratory failure or multiple organ failure, with the mortality rate being equivalent to complex cardiovascular and cerebrovascular diseases ( 2 ). Thus, the constitutive and induced expression of TLR4 in immunocompromised patients with A. baumannii infection is to be investigated.…”