Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment.
The emergence of multidrug-resistant (MDR) Acinetobacter baumannii poses a therapeutic problem. The aim of this study was to assess the risk factors for nosocomial MDR-A. baumannii bloodstream infection (BSI) and the efficacy of ampicillin-sulbactam (A/S) in its treatment. Of 94 nosocomial A. baumannii BSI during the year 2000, 54% involved MDR strains, 81% of which were genetically related. Various risk factors for MDR-A. baumannii were found, of which intensive-care unit admission and prior aminoglycoside therapy were independently associated with MDR-A. baumannii acquisition on multivariate analysis. Of MDR-A. baumannii BSI cases, 65% received A/S and 35% inadequate antibiotic therapy, whereas of 43 non-MDR cases, 86% were treated according to susceptibility and 14% inappropriately with antibiotics to which these organisms were resistant. Crude mortality was comparable in the adequately treated groups. Respective mortalities among patients treated adequately and inadequately were 41.4 and 91.7% (p<0.001). Among severely ill patients, A/S therapy significantly decreased the risk of death (P=0.02 OR=7.64). MDR-A. baumannii has become highly endemic in our institution. A/S appears to be one of the last effective and safe empirical resorts for treatment of MDR A. baumannii BSI.
Smolyakov
R
R
Infectious Disease Institute, Soroka University Medical Centre and the Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Borer
A
A
Riesenberg
K
K
Schlaeffer
F
F
Alkan
M
M
Porath
A
A
Rimar
D
D
Almog
Y
Y
Gilad
J
J
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D000368:Aged; D000667:Ampicillin / Q000494:pharmacology* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004269:DNA, Bacterial / Q000032:analysis; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007362:Intensive Care Units; D007557:Israel / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D013407:Sulbactam / Q000494:pharmacology* / Q000627:therapeutic use
D004269:DNA, Bacterial; C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam