Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases
Tülay Özvatan
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorCorresponding Author
Halis Akalın
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Correspondence: Halis Akalın, Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa 16059, Turkey. Email: [email protected]Search for more papers by this authorMelda Sınırtaş
Department of Microbiology and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorGökhan Ocakoğlu
Department of Biostatistics, Uludag University, Bursa, Turkey
Search for more papers by this authorEmel Yılmaz
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorYasemin Heper
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorNermin Kelebek
Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
Search for more papers by this authorRemzi İşçimen
Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
Search for more papers by this authorFerda Kahveci
Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
Search for more papers by this authorTülay Özvatan
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorCorresponding Author
Halis Akalın
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Correspondence: Halis Akalın, Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa 16059, Turkey. Email: [email protected]Search for more papers by this authorMelda Sınırtaş
Department of Microbiology and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorGökhan Ocakoğlu
Department of Biostatistics, Uludag University, Bursa, Turkey
Search for more papers by this authorEmel Yılmaz
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorYasemin Heper
Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
Search for more papers by this authorNermin Kelebek
Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
Search for more papers by this authorRemzi İşçimen
Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
Search for more papers by this authorFerda Kahveci
Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
Search for more papers by this authorAbstract
Background and objective
Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms.
Methods
The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia.
Results
Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49–4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75–13.64; P < 0.001), APACHE II score ≥ 20 (OR, 2.12; 95% CI: 1.28–3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00–2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11–5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)–46/123 (37.4%), P = 0.037 and 62/93 (66.7%)–65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains.
Conclusion
Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.
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