title: Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases.
abstract: OBJECTIVE
  Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms.
  
  
  METHODS
  The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia.
  
  
  RESULTS
  Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49-4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75-13.64; P < 0.001), APACHE II score ≥ 20 (OR, 2.12; 95% CI: 1.28-3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00-2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11-5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)-46/123 (37.4%), P = 0.037 and 62/93 (66.7%)-65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains.
  
  
  CONCLUSIONS
  Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey.
authors.forename: Tülay
authors.initials: T
authors.lastname: Özvatan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey.
authors.forename: Halis
authors.initials: H
authors.lastname: Akalın
authors.affiliation: Department of Microbiology and Clinical Microbiology, Uludag University, Bursa, Turkey.
authors.forename: Melda
authors.initials: M
authors.lastname: Sınırtaş
authors.affiliation: Department of Biostatistics, Uludag University, Bursa, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Ocakoğlu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Yılmaz
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Heper
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Nermin
authors.initials: N
authors.lastname: Kelebek
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Remzi
authors.initials: R
authors.lastname: İşçimen
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey.
authors.forename: Ferda
authors.initials: F
authors.lastname: Kahveci
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D040981:Acinetobacter baumannii; D016954:Acinetobacter calcoaceticus; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality*
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem
keywords: Acinetobacter baumannii; colistin; nosocomial pneumonia; pneumonia; ventilator-associated pneumonia