Impact of inappropriate antimicrobial therapy on outcome in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii.
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.
Joung
Mi Kyong
MK
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Kwon
Ki Tae
KT
Kang
Cheol-In
CI
Cheong
Hae Suk
HS
Rhee
Ji-young
JY
Jung
Dong Sik
DS
Chung
Seung Min
SM
Lee
Jeong A
JA
Moon
Soo-youn
SY
Ko
Kwan Soo
KS
Chung
Doo Ryeon
DR
Lee
Nam Yong
NY
Song
Jae-Hoon
JH
Peck
Kyong Ran
KR
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
D000900:Anti-Bacterial Agents