title: Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii.
abstract: BACKGROUND
  There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistin-only-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB.
  
  
  METHODS
  Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality.
  
  
  RESULTS
  A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days.
  
  
  CONCLUSIONS
  A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.
authors: Jordan University of Science and Technology, Irbid, Jordan. samrah@just.edu.jo.
authors: Shaher
authors: S
authors: Samrah
authors: Yazan
authors: Y
authors: Bashtawi
authors: Wail
authors: W
authors: Hayajneh
authors: Basima
authors: B
authors: Almomani
authors: Suleiman
authors: S
authors: Momany
authors: Yousef
authors: Y
authors: Khader
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin