[Multidrug-resistant Acinetobacter baumannii infection in respiratory intensive care unit].
Multidrug-resistant Acinetobacter boumannii is a challenge in the treatment and control of nosocomial infections. This retrospective study was aimed to investigate the prevalence of multidrug resistant A. boumannii in a respiratory intensive care unit (ICU), related risk factors and its impact on disease prognosis. Of 218 patients who were hospitalized in our ICU during the last two years; 37 (17%) patients (21 males, mean age 61.6 +/- 19.8 years) developed pneumonia and/or bacteremia due to multidrug-resistant A. baumannii. Previous antibiotic therapy was detected in 51.4% and hospitalization in 70.3% of the cases. Pneumonia (59.5%) was the most frequent cause of hospitalization and chronic obstructive pulmonary disease (21.6%) was the second one; 81.1% of patients had co-morbidity. Invasive mechanical ventilation was performed in 31 (83.7%) patients during the follow-up. Ventilator-associated pneumonia developed in 22 (59.5%) patients and bacteraemia in 9 (24.3%) patients. Multidrug-resistance was observed in 23 (62.2%) of patients. Highest rates of resistance (100%) was detected against piperacillin-tazobactam, ampicillin-sulbactam and ciprofloxacin, followed by imipenem and cefepime (78%), meropenem and ceftazidime (55%), cefoperazone-sulbactam (43%) and netilmicin (35.1). The rates of re-intubation and tracheotomy were higher in patients infected with A. boumannii compared to the control group (59.5% vs. 7.7%, p < 0.0001 and 21.6% vs. 3.9%, p = 0.001, respectively). There was no significant difference between two groups in terms of mortality, however, durations of ICU and hospital stays were longer in patients with multidrug-resistant A. baumannii infection than without infection (24.2 +/- 18.3 vs. 8.2 +/- 8.3 days, p < 0.001 and 33.3 +/- 19.8 vs. 15.4 +/- 11.4 days, p < 0.001, respectively). In conclusion, due to the high rates of drug-resistance in nosocomial A.baumannii isolates, the use of invasive procedures and durations of ICU and hospital stays exhibit an increasing trend.
Bacakoğlu
Feza
F
Ege Universitesi Tip Fakültesi, Göğüs Hastaliklari Anabilim Dali, Izmir. fezabacakoglu@yahoo.com
Korkmaz Ekren
Pervin
P
Taşbakan
Mehmet Sezai
MS
Başarik
Burcu
B
Pullukçu
Hüsnü
H
Aydemir
Söhret
S
Gürgün
Alev
A
Başoğlu
Ozen Kaçmaz
OK
D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D040981:Acinetobacter baumannii / Q000187:drug effects*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology