Impact of inappropriate antimicrobial therapy on outcome in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii.

Abstract

OBJECTIVES:

The purpose of this study was to evaluate the impact of inappropriate antimicrobial therapy on the outcome of patients with hospital-acquired pneumonia (HAP) caused by Acinetobacter baumannii.

METHODS:

All cases of HAP caused by A. baumannii from January 2000 to March 2006 at the Samsung Medical Center (Seoul, Korea) were analyzed retrospectively.

RESULTS:

A total of 116 patients with clinically significant Acinetobacter HAP were enrolled. Among the A. baumannii isolates, 60.3% showed multi-drug resistance (MDR), 16.4% were found to have imipenem resistance, and 15.5% had pan-drug resistance (PDR). The mean APACHE II score of the patients was 22.3 +/- 7.9. The overall in-hospital and pneumonia-related mortality rates were 47.4% and 37.9%, respectively. The univariate analysis showed that the factors associated with pneumonia-related mortality were: MDR, PDR, high APACHE II score, inappropriate empirical antimicrobial therapy, and inappropriate definitive antimicrobial treatment (All p < 0.05). Among these, a high APACHE II score and inappropriate definitive antimicrobial therapy were found to be independent factors associated with a high mortality, after adjustment for other variables.

CONCLUSIONS:

The appropriate definitive antimicrobial therapy should be provided in patients with HAP caused by A. baumannii.

• Authors: Mi Kyong Joung, Ki Tae Kwon, Cheol-In Kang, Hae Suk Cheong, Ji-young Rhee, Dong Sik Jung, Seung Min Chung, Jeong A Lee, Soo-youn Moon, Kwan Soo Ko, Doo Ryeon Chung, Nam Yong Lee, Jae-Hoon Song, Kyong Ran Peck
• Journal: The Journal of infection (J Infect) Vol. 61 Issue 3 Pg. 212-8 (Sep 2010) ISSN: 1532-2742 [Electronic] England
• PMID: 20600295 (Publication Type: Journal Article)
• Copyright: Copyright 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• APACHE
• Acinetobacter Infections (drug therapy, microbiology)
• Acinetobacter baumannii (isolation & purification)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Analysis of Variance
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Cross Infection (drug therapy, microbiology)
• Drug Resistance, Multiple, Bacterial
• Female
• Humans
• Inappropriate Prescribing
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Pneumonia, Bacterial (drug therapy, microbiology)
• Retrospective Studies
• Risk Factors
• Treatment Outcome