title: Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia.
abstract: OBJECTIVE
  To investigate the impact of imipenem resistance on the mortality rate among patients with Acinetobacter bacteraemia.
  
  
  METHODS
  A retrospective, pairwise-matched (1:1), risk-adjusted (age, Pitt bacteraemia score) cohort study was performed at three tertiary care hospitals in Korea from January 2000 to June 2005.
  
  
  RESULTS
  Forty patients with imipenem non-susceptible Acinetobacter bacteraemia (INAB group) and 40 matched subjects (1:1 ratio) with imipenem-susceptible Acinetobacter bacteraemia (ISAB group) were included. Both groups had similar clinical features related to the severity of illness. The 30 day mortality rate was higher in the INAB group (57.5%) than the ISAB group (27.5%) (P = 0.007). The rate of discordant antimicrobial therapy was higher in the INAB group (65.0%) than the ISAB group (20.0%) (P < 0.001). The 30 day mortality rate was higher in the patients with discordant antimicrobial therapy (67.6%) than concordant antimicrobial therapy (23.9%) (P < 0.001). Multivariate analysis showed that age, the Pitt bacteraemia score, immunosuppressive status, and discordant antimicrobial therapy were independent risk factors for 30 day mortality among patients with Acinetobacter bacteraemia (P < 0.05). When discordant antimicrobial therapy was excluded in the multivariate analysis, the imipenem resistance was associated with 30 day mortality (P = 0.005).
  
  
  CONCLUSIONS
  Imipenem resistance has a significant impact on the mortality rate among patients with Acinetobacter bacteraemia, and this is mainly attributable to the higher rate of discordant antimicrobial therapy.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Seoul 135-710, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kwon
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Oh
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Hyun-Ha
authors.initials: HH
authors.lastname: Chang
authors.forename: Sook-In
authors.initials: SI
authors.lastname: Jung
authors.forename: Shin-Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Seong Yeol
authors.initials: SY
authors.lastname: Ryu
authors.forename: Sang Taek
authors.initials: ST
authors.lastname: Heo
authors.forename: Dong Sik
authors.initials: DS
authors.lastname: Jung
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Rhee
authors.forename: Sang Yop
authors.initials: SY
authors.lastname: Shin
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem