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Prognostic factors associated with mortality of drug-resistant Acinetobacter baumannii ventilator-associated pneumonia.

Inchai J, Pothirat C, Bumroongkit C, Limsukon A, Khositsakulchai W, Liwsrisakun C - J Intensive Care (2015)

Bottom Line: We identified the prognostic factors of 30-day mortality in patients with VAP caused by drug-resistant A. baumannii and compared survival outcomes among multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii VAP.Drug-resistant A. baumannii, particularly XDR and PDR, was associated with a high mortality rate.Septic shock, high SAPS II, high SOFA score, and inappropriate initial antibiotic treatment were independent prognostic factors for 30-day mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand.

ABSTRACT

Background: Ventilator-associated pneumonia (VAP) caused by drug-resistant Acinetobacter baumannii is associated with high mortality in critically ill patients. We identified the prognostic factors of 30-day mortality in patients with VAP caused by drug-resistant A. baumannii and compared survival outcomes among multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii VAP.

Methods: A retrospective cohort study was conducted in the Medical Intensive Care Unit at Chiang Mai University Hospital, Thailand. All adult patients diagnosed with A. baumannii VAP between 2005 and 2011 were eligible. Univariable and multivariable Cox's proportional hazards regression were performed to identify the prognostic factors of 30-day mortality.

Results: A total of 337 patients with microbiologically confirmed A. baumannii VAP were included. The proportion of drug-sensitive (DS), MDR, XDR, and PDR A. baumannii were 9.8%, 21.4%, 65.3%, and 3.6%, respectively. The 30-day mortality rates were 21.2%, 31.9%, 56.8%, and 66.7%, respectively. The independent prognostic factors were SOFA score >5 (hazard ratio (HR) = 3.33, 95% confidence interval (CI) 1.94-5.72, P < 0.001), presence of septic shock (HR = 2.66, 95% CI 1.71-4.12, P < 0.001), Simplified Acute Physiology Score (SAPS) II >45 (HR = 1.58, 95% CI 1.01-2.46, P = 0.045), and inappropriate initial antibiotic treatment (HR = 1.53, 95% CI 1.08-2.20, P = 0.016).

Conclusions: Drug-resistant A. baumannii, particularly XDR and PDR, was associated with a high mortality rate. Septic shock, high SAPS II, high SOFA score, and inappropriate initial antibiotic treatment were independent prognostic factors for 30-day mortality.

No MeSH data available.


Related in: MedlinePlus

Survival outcome of patients with VAP caused by DS, MDR, XDR, and PDRA. baumannii.
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Fig1: Survival outcome of patients with VAP caused by DS, MDR, XDR, and PDRA. baumannii.

Mentions: A total of 337 patients with microbiologically confirmed A. baumannii VAP were reviewed over 7 years. There were 154 (45.7%) males and 183 (54.3%) females with a mean age of 61.6 ± 18.0 years. Late-onset VAP was seen in 88.6% of the patients. The CPIS was 8.2 ± 1.4. The SAPS II and SOFA score were 46.3 ± 14.2 and 6.7 ± 2.7, respectively. The categories of drug-resistant patterns of A. baumannii VAP were DS 33 (9.8%), MDR 72 (21.4%), XDR 220 (65.3%), and PDR A. baumannii 12 (3.6%). The 30-day mortality rates were 21.2%, 31.9%, 56.8%, and 66.7%, respectively (Tables 1 and 2). The survival outcome among DS, MDR, XDR, and PDR A. baumannii is shown in Figure 1. The median duration of mechanical ventilation and hospitalization before VAP onset was 9 and 10 days, respectively. Although 91.1% of the patients received early initial antibiotic treatment, only 56.1% of them were appropriate (Table 2). The overall 30-day, ICU, and in-hospital mortality rates were 48.4%, 32.0% and 53.3%, respectively (Table 3).Table 1


Prognostic factors associated with mortality of drug-resistant Acinetobacter baumannii ventilator-associated pneumonia.

Inchai J, Pothirat C, Bumroongkit C, Limsukon A, Khositsakulchai W, Liwsrisakun C - J Intensive Care (2015)

Survival outcome of patients with VAP caused by DS, MDR, XDR, and PDRA. baumannii.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940762&req=5

Fig1: Survival outcome of patients with VAP caused by DS, MDR, XDR, and PDRA. baumannii.
Mentions: A total of 337 patients with microbiologically confirmed A. baumannii VAP were reviewed over 7 years. There were 154 (45.7%) males and 183 (54.3%) females with a mean age of 61.6 ± 18.0 years. Late-onset VAP was seen in 88.6% of the patients. The CPIS was 8.2 ± 1.4. The SAPS II and SOFA score were 46.3 ± 14.2 and 6.7 ± 2.7, respectively. The categories of drug-resistant patterns of A. baumannii VAP were DS 33 (9.8%), MDR 72 (21.4%), XDR 220 (65.3%), and PDR A. baumannii 12 (3.6%). The 30-day mortality rates were 21.2%, 31.9%, 56.8%, and 66.7%, respectively (Tables 1 and 2). The survival outcome among DS, MDR, XDR, and PDR A. baumannii is shown in Figure 1. The median duration of mechanical ventilation and hospitalization before VAP onset was 9 and 10 days, respectively. Although 91.1% of the patients received early initial antibiotic treatment, only 56.1% of them were appropriate (Table 2). The overall 30-day, ICU, and in-hospital mortality rates were 48.4%, 32.0% and 53.3%, respectively (Table 3).Table 1

Bottom Line: We identified the prognostic factors of 30-day mortality in patients with VAP caused by drug-resistant A. baumannii and compared survival outcomes among multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii VAP.Drug-resistant A. baumannii, particularly XDR and PDR, was associated with a high mortality rate.Septic shock, high SAPS II, high SOFA score, and inappropriate initial antibiotic treatment were independent prognostic factors for 30-day mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand.

ABSTRACT

Background: Ventilator-associated pneumonia (VAP) caused by drug-resistant Acinetobacter baumannii is associated with high mortality in critically ill patients. We identified the prognostic factors of 30-day mortality in patients with VAP caused by drug-resistant A. baumannii and compared survival outcomes among multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii VAP.

Methods: A retrospective cohort study was conducted in the Medical Intensive Care Unit at Chiang Mai University Hospital, Thailand. All adult patients diagnosed with A. baumannii VAP between 2005 and 2011 were eligible. Univariable and multivariable Cox's proportional hazards regression were performed to identify the prognostic factors of 30-day mortality.

Results: A total of 337 patients with microbiologically confirmed A. baumannii VAP were included. The proportion of drug-sensitive (DS), MDR, XDR, and PDR A. baumannii were 9.8%, 21.4%, 65.3%, and 3.6%, respectively. The 30-day mortality rates were 21.2%, 31.9%, 56.8%, and 66.7%, respectively. The independent prognostic factors were SOFA score >5 (hazard ratio (HR) = 3.33, 95% confidence interval (CI) 1.94-5.72, P < 0.001), presence of septic shock (HR = 2.66, 95% CI 1.71-4.12, P < 0.001), Simplified Acute Physiology Score (SAPS) II >45 (HR = 1.58, 95% CI 1.01-2.46, P = 0.045), and inappropriate initial antibiotic treatment (HR = 1.53, 95% CI 1.08-2.20, P = 0.016).

Conclusions: Drug-resistant A. baumannii, particularly XDR and PDR, was associated with a high mortality rate. Septic shock, high SAPS II, high SOFA score, and inappropriate initial antibiotic treatment were independent prognostic factors for 30-day mortality.

No MeSH data available.


Related in: MedlinePlus