title: Impact of inappropriate antimicrobial therapy on outcome in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of inappropriate antimicrobial therapy on the outcome of patients with hospital-acquired pneumonia (HAP) caused by Acinetobacter baumannii.
  
  
  METHODS
  All cases of HAP caused by A. baumannii from January 2000 to March 2006 at the Samsung Medical Center (Seoul, Korea) were analyzed retrospectively.
  
  
  RESULTS
  A total of 116 patients with clinically significant Acinetobacter HAP were enrolled. Among the A. baumannii isolates, 60.3% showed multi-drug resistance (MDR), 16.4% were found to have imipenem resistance, and 15.5% had pan-drug resistance (PDR). The mean APACHE II score of the patients was 22.3 +/- 7.9. The overall in-hospital and pneumonia-related mortality rates were 47.4% and 37.9%, respectively. The univariate analysis showed that the factors associated with pneumonia-related mortality were: MDR, PDR, high APACHE II score, inappropriate empirical antimicrobial therapy, and inappropriate definitive antimicrobial treatment (All p < 0.05). Among these, a high APACHE II score and inappropriate definitive antimicrobial therapy were found to be independent factors associated with a high mortality, after adjustment for other variables.
  
  
  CONCLUSIONS
  The appropriate definitive antimicrobial therapy should be provided in patients with HAP caused by A. baumannii.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Mi Kyong
authors.initials: MK
authors.lastname: Joung
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kwon
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Hae Suk
authors.initials: HS
authors.lastname: Cheong
authors.forename: Ji-young
authors.initials: JY
authors.lastname: Rhee
authors.forename: Dong Sik
authors.initials: DS
authors.lastname: Jung
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Chung
authors.forename: Jeong A
authors.initials: JA
authors.lastname: Lee
authors.forename: Soo-youn
authors.initials: SY
authors.lastname: Moon
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents