Predictive value of the serum bactericidal test for mortality in patients infected with multidrug-resistant Acinetobacter baumannii.
OBJECTIVE
Strains of Acinetobacter baumannii resistant to all available antibiotics except polymyxin B have circulated in Taiwan since 1998 and have caused a variety of nosocomial infections. There are no standard tests to measure outcome in patients infected with these strains. Our aim was to determine whether a serum bactericidal test (SBT) could be used for this purpose.


METHODS
This SBT was performed in 57 infected patients.


RESULTS
Among the 35 patients who survived and 22 patients who died, peak SBT titer negatively correlated with mortality rate (correlation coefficient -0.43). The survival rate in patients with a peak SBT titer > or = 1:16, > or = 1:8, and < or = 1:4 was 100%, 87.5%, and 42.4%, respectively (p=0.001). Mortality was found to be closely related to illness severity and the presence of multiple organ failure. In subgroup analysis, the power of SBT to predict mortality was significant for patients without multiple organ failure (p=0.004), and also patients without disease defined as rapidly fatal by McCabe classification (p=0.044).


CONCLUSIONS
In a region with few therapeutic options for multi-drug resistant Acinetobacter baumannii (MDRAB), such as in Taiwan, SBT could be used as a prognosis indicator and indicator of the need to modify treatment in patients infected with MDRAB.
Liao
Chun-Hsing
CH
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei 100, Taiwan.
Sheng
Wang-Huei
WH
Chen
Yee-Chun
YC
Hung
Chien-Ching
CC
Wang
Jann-Tay
JT
Chang
Shan-Chwen
SC
D000151:Acinetobacter Infections / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015610:Serum Bactericidal Test / Q000379:methods / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013624:Taiwan
D000900:Anti-Bacterial Agents