Acinetobacter baumannii ventilator-associated pneumonia : epidemiological and clinical findings

To investigate prognostic factors and predictors of Acinetobacter baumannii isolation in ventilator-associated pneumonia (VAP). We specifically analyzed these issues for imipenem-resistant episodes. All episodes of VAP are prospectively included in a database. Information about risk factors was retr...

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Bibliographic Details
Published in:Intensive care medicine 2005-05, Vol.31 (5), p.649-655
Main Authors: GARNACHO-MONTERO, José, ORTIZ-LEYBA, C, FERNANDEZ-HINOJOSA, Esteban, ALDABO-PALLAS, Teresa, CAYUELA, Aurelio, MARQUEZ-VACARO, Juan A, GARCIA-CURIEL, Andrés, JIMENEZ-JIMENEZ, F. J
Format: Article
Language:English
Subjects:
Acinetobacter baumannii
Acinetobacter Infections - drug therapy
Acinetobacter Infections - epidemiology
Acinetobacter Infections - etiology
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Biological and medical sciences
Cross Infection - drug therapy
Cross Infection - epidemiology
Cross Infection - etiology
Drug Resistance, Bacterial
Emergency and intensive respiratory care
Epidemics
Epidemiology
Female
Health and social institutions
Hospitals
Humans
Imipenem - pharmacology
Imipenem - therapeutic use
Intensive care
Intensive care medicine
Male
Medical prognosis
Medical sciences
Middle Aged
Multivariate Analysis
Nosocomial infections
Organization
Pathogens
Patients
Pneumonia
Pneumonia, Bacterial - drug therapy
Pneumonia, Bacterial - epidemiology
Pneumonia, Bacterial - etiology
Prognosis
Prospective Studies
Public health. Hygiene
Public health. Hygiene-occupational medicine
Regression Analysis
Respiration, Artificial - adverse effects
Retrospective Studies
Risk Factors
Spain - epidemiology
Ventilators
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Description
Summary:To investigate prognostic factors and predictors of Acinetobacter baumannii isolation in ventilator-associated pneumonia (VAP). We specifically analyzed these issues for imipenem-resistant episodes. All episodes of VAP are prospectively included in a database. Information about risk factors was retrieved retrospectively. Eighty-one patients exhibiting microbiologically documented VAP: 41 by A. baumannii (26 by imipenem-resistant) and 40 by other pathogens. The following variables were noted: underlying diseases, severity of illness, duration of mechanical ventilation and of hospitalization before VAP, prior episode of sepsis, previous antibiotic, corticosteroid use, type of nutrition, renal replacement therapy, reintubation, transportation out of the ICU, micro-organisms involved in VAP, concomitant bacteremia, clinical presentation, Sequential Organ Failure Assessment (SOFA) scale on the day of diagnosis, and adequacy of empirical antibiotic therapy. Prior antibiotic use was found to be associated with development of VAP by A. baumannii (OR 14). Prior imipenem exposure was associated with the isolation of imipenem-resistant strains (OR 4). SOFA score on the day of diagnosis was the only predictor of in-hospital mortality (OR 1.22); adequacy of empirical antibiotic therapy was a protective factor (OR 0.067). Our results confirm that prior exposure to antimicrobials is an independent predictor for the development of A. baumannii VAP, the prognosis of which is similar to that of infections caused by other pathogens. This study highlights the importance of initial antibiotic choice in VAP or whatever cause.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-005-2598-0