title: High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia.
abstract: BACKGROUND
  Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality. Increasing antimicrobial resistance has aroused the concern of the failure of antibiotic treatment.
  
  
  OBJECTIVE
  To determine the distribution of the bacterial isolates of HAP and VAP, their antimicrobial resistance patterns, and impact of discordant antibiotic therapy on clinical outcome in Asian countries
  
  
  METHODS
  A prospective surveillance study was conducted in 73 hospitals in 10 Asian countries from 2008-2009. A total of 2,554 cases with HAP or VAP in adults were enrolled and 2,445 bacterial isolates were collected from 1,897 cases. Clinical characteristics and antimicrobial resistance profiles were analyzed.
  
  
  RESULTS
  Major bacterial isolates from HAP and VAP cases in Asian countries were Acinetobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. Imipenem resistance rates of Acinetobacter and P. aeruginosa were 67.3% and 27.2%, respectively. Multidrug-resistant rates were 82% and 42.8%, and extensively drug-resistant rates were 51.1% and 4.9%. Multidrug-resistant rate of K. pneumoniae was 44.7%. Oxacillin resistance rate of S. aureus was 82.1%. All-cause mortality rate was 38.9%. Discordant initial empirical antimicrobial therapy increased the likelihood of pneumonia-related mortality (odds ratio, 1.542; 95% confidence interval, 1.127-2.110).
  
  
  CONCLUSIONS
  Acinetobacter spp., P. aeruginosa, S. aureus, and K. pneumoniae are the most frequent isolates from adults with HAP or VAP in Asian countries. These isolates are highly resistant to major antimicrobial agents, which could limit the therapeutic options in the clinical practice. Discordant initial empirical antimicrobial therapy significantly increases the likelihood of pneumonia-related mortality.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Visanu
authors.initials: V
authors.lastname: Thamlikitkul
authors.forename: Shao-Guang
authors.initials: SG
authors.lastname: Huang
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Thomas Man-Kit
authors.initials: TM
authors.lastname: So
authors.forename: Rohani M D
authors.initials: RM
authors.lastname: Yasin
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Celia C
authors.initials: CC
authors.lastname: Carlos
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu
authors.forename: Latre
authors.initials: L
authors.lastname: Buntaran
authors.forename: M K
authors.initials: MK
authors.lastname: Lalitha
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
mesh_terms: D000150:Acinetobacter; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001208:Asia / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents