Impact of appropriate antimicrobial therapy on survival in patients with Acinetobacter baumannii-associated infections

Yıl 2013, Cilt: 3 Sayı: 04, 163 - 168, 01.12.2013

Yury Gorbich Igor Karpov Olga Kretchikova

https://doi.org/10.5799/jmid.123074

Öz

Objective: To assess the impact of inappropriate antimicrobial treatment on the 30-day mortality in patients with Acinetobacter baumannii associated infections. Methods: 87 patients with nosocomial infections caused by A. baumannii were included in the study. Among them 39 patients had favorable outcome, while 48 patients died within 30 days after pathogen isolation. In order to assess the impact of antimicrobial therapy on outcomes, the cases with appropriate antimicrobial treatment from both studied groups were compared with the cases in which patient\'s received inappropriate therapy. The Chi-square or Z-test was used to assess differences in categorical variables. Continuous variables were compared using the Mann-Whitney test. Results: Among patients with favorable outcomes four people received appropriate empirical antimicrobial treatment, while in the other group only three patients. The odds ratio was 1.7 (95% CI 0.4-8.2; p=0.77). Appropriate antimicrobial agents were administered as a part of causal treatment to 27 patients who survived and to 11 patients who died within 30 days after pathogen isolation. The odds ratio was 6.7 (95% CI 2.6-17.3; p<0.001). Conclusion: Our study has revealed that appropriate causal antimicrobial therapy decreases 30-day mortality rate in patients with nosocomial infections caused by A. baumannii.

Anahtar Kelimeler

Acinetobacter

Impact of appropriate antimicrobial therapy on survival in patients with Acinetobacter baumannii-associated infections

Öz

Amaç: Acinetobacter baumannii ilişkili enfeksiyonları olan hastalarda uygunsuz antimikrobiyal tedavinin 30 günlük mortaliteye etkisini değerlendirmek Yöntemler: A. baumannii ’nin neden olduğu 87 hastane enfeksiyonlu hasta çalışmaya dahil edildi. Hastalardan 39’unda olumlu sonuç alınırken 48 hasta patojen izolasyondan sonraki 30 gün içinde öldü. Antimikrobiyal tedavinin akıbet üzerine etkisini değerlendirmek amacıyla, çalışılan gruplardan uygun antimikrobiyal tedavi ile uygunsuz tedavi alan hastalar karşılaştırıldı. Kategorik değişkenlerin farklılıklarını değerlendirmek için Ki-kare veya Z-testi kullanıldı. Sürekli değişkenler Mann-Whitney testi ile karşılaştırıldı.Bulgular: Olumlu sonuçları olan hastalardan sadece dört kişi uygun ampirik antibiyotik tedavisi alırken diğer grupta bu yalnız üç hastaydı. Odds oranı 1,7 (% 95 CI 0,4-8,2, p=0,77) idi. Temel tedavinin bir parçası olarak uygun antimikrobiyal ajanlar uygulanarak tedavi verilen 27 hasta yaşarken, patojen izolasyondan sonra 30 gün içinde 11 hasta öldü. Odds oranı 6,7 (% 95 CI 2,6-17,3; p <0.001) idi.Sonuç: Bizim çalışmamız; nedene yönelik uygun antibiyotik tedavisinin A. baumannii’ye bağlı hastane enfeksiyonları olan hastalarda 30 günlük mortalite oranını azalttığını ortaya koymuştur

Anahtar Kelimeler

Acinetobacter baumannii, mortalite, antimikrobial tedavi, nozokomiyal infeksion

Kaynakça

• Chopra I, Schofield C, Everett M, et al. Treatment of health- care-associated infections caused by Gram-negative bacte- ria: a consensus statement. Lancet Infect Dis 2008;8:133- 139.
• Xie D, Xiong W, Xiang L, et al. Point prevalence surveys of healthcare-associated infection in 13 hospitals in Hubei Province, China, 2007-2008. J Hosp Infect 2010;76:150-155.
• Tekin R, Dal T, Pirinccioglu H, Erisir Oygucu S. A 4-Year Sur- veillance of Device-associated Nosocomial Infections in a Neonatal Intensive Care Unit. Pediatr Neonatol 2013. doi: 10.1016/j.pedneo.2013.03.011.
• Bereket W, Hemalatha K, Getenet B, et al. Update on bac- terial nosocomial infections. Eur Rev Med Pharmacol Sci 2012;16:1039-1044.
• Brauers J, Frank U, Kresken M, et al. Activities of various beta- lactams and beta-lactam/beta-lactamase inhibitor combina- tions against Acinetobacter baumannii and Acinetobacter DNA group 3 strains. Clin Microbiol Infect 2005;11:24-30.
• Karageorgopoulos DE, Falagas ME. Current control and treat- ment of multidrug-resistant Acinetobacter baumannii infec- tions. Lancet Infect Dis 2008;8:751-762.
• Michalopoulos A, Falagas ME. Treatment of Acinetobacter in- fections. Expert Opin Pharmacother 2010;11:779-788.
• Giamarellou H, Antoniadou A, Kanellakopoulou K. Acineto- bacter baumannii: a universal threat to public health? Int J Antimicrob Agents 2008;32:106-119.
• Fishbain J, Peleg AY. Treatment of Acinetobacter Infections. Clin Infect Dis 2010;51:79-84.
• Savini V, Catavitello C, Pompetti F, et al. Isolation of uncom- mon respiratory and enteric Acinetobacter baumannii from hematologic patients and emergence of tigecycline-resis- tance. J Infect 2008;57:497-500.
• Van Looveren M, Goossens H, ARPAC Steering Group. An- timicrobial resistance of Acinetobacter spp. in Europe. Clin Microbiol Infect 2004;10:684-704.
• De Pascale G, Pompucci A, Maviglia R, et al. Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with intrathecal and intravenous colistin. Minerva Anestesiol 2010;76:957-960.
• Eberle BM, Schnüriger B, Putty B, et al. The impact of Aci- netobacter baumannii infections on outcome in trauma pa- tients: a matched cohort study. Crit Care Med 2010;38:2133- 2138.
• Garnacho-Montero J, Ortiz-Leyba C, Fernández-Hinojosa E, et al. Acinetobacter baumannii ventilator-associated pneu- monia: epidemiological and clinical findings. Intensive Care Med 2005;31:649-655.
• Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 2003; 29:471- 475.
• Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control stud- ies. Crit Care 2006;10:R48.
• Falagas ME, Rafailidis PI. Attributable mortality of Acineto- bacter baumannii: no longer a controversial issue. Crit Care 2007;11:134.
• Erbay A, Idil A, Gözel MG, et al. Impact of early appropriate antimicrobial therapy on survival in Acinetobacter baumannii bloodstream infections. Int J Antimicrob Agents 2009;34:575- 579.
• Performance Standards for Antimicrobial Susceptibility Test- ing; Twenty-first informational supplement. M 100-S21. Clini- cal and Laboratory Standards Institute 2011;31:1.
• Joung MK, Kwon KT, Kang C-I, et al. Impact of inappropriate antimicrobial therapy on outcome in patients with hospital- acquired pneumonia caused by Acinetobacter baumannii. J Infect 2010;61:212-218.
• Zheng Y-L, Wan Y-F, Zhou L-Y, et al. Risk factors and mor- tality of patients with nosocomial carbapenem-resistant Aci- netobacter baumannii pneumonia. Am J Infect Control 2013; 41:e59-63.
• Lee Y-T, Kuo S-C, Yang S-P, et al. Impact of appropriate anti- microbial therapy on mortality associated with Acinetobacter baumannii bacteremia: relation to severity of infection. Clin Infect Dis 2012;55:209-215.
• Santimaleeworagun W, Wongpoowarak P, Chayakul P, et al. Clinical outcomes of patients infected with carbapenem-re- sistant Acinetobacter baumannii treated with single or com- bination antibiotic therapy. J Med Assoc Thail Chotmaihet Thangphaet 2011;94:863-870.
• Vitkauskiene A, Dambrauskiene A, Cerniauskiene K, et al. Risk factors and outcomes in patients with carbapen- em-resistant Acinetobacter infection. Scand J Infect Dis 2013;45:213-218.
• Esterly JS, Griffith M, Qi C, et al. Impact of carbapenem resis- tance and receipt of active antimicrobial therapy on clinical outcomes of Acinetobacter baumannii bloodstream infec- tions. Antimicrob Agents Chemother 2011;55:4844-4849.
• Lemos EV, de la Hoz FP, Alvis N, et al. Impact of carbape- nem resistance on clinical and economic outcomes among patients with Acinetobacter baumannii infection in Colombia. Clin Microbiol Infect 2013. doi: 10.1111/1469-0691.12251.
• Lin H-C, Lin S-M, Kuo C-H, et al. Incidence and outcome of healthcare-associated Acinetobacter baumannii in chroni- cally ventilated patients in a tertiary care hospital in Taiwan. Am J Med Sci 2011;341:361-366.
• Lee N-Y, Lee J-C, Li M-C, et al. Empirical antimicrobial thera- py for critically ill patients with Acinetobacter baumannii bac- teremia: Combination is better. J Microbiol Immunol Infect 2013. doi: 10.1016/j.jmii.2013.03.004.
• Jamal W, Salama M, Dehrab N, et al. Role of tigecycline in the control of a carbapenem-resistant Acinetobacter bau- mannii outbreak in an intensive care unit. J Hosp Infect 2009;72:234-242.
• Le Hello S, Falcot V, Lacassin F, et al. Risk factors for car- bapenem-resistant Acinetobacter baumannii infections at a tertiary care hospital in New Caledonia, South Pacific. Scand J Infect Dis 2010; 42:821-826.
• Gootz TD, Marra A. Acinetobacter baumannii: an emerg- ing multidrug-resistant threat. Expert Rev Anti Infect Ther 2008;6:309-325.