Clinical response and outcome of pneumonia due to multi-drug resistantAcinetobacter baumanniiin critically ill patients.
OBJECTIVE
The frequency of multi-drug resistantAcinetobacter spp. infections is increasing in Iran. Considering availability of limited therapeutic options, clinical response and outcome of ventilator-associated pneumonia due to multi-drug resistantA.baumanniiwere evaluated in critically ill patients.


METHODS
In this prospective study, 29 patients with carbapenem resistanceA. baumanniiventilator-associated pneumonia were enrolled. Endotracheal aspirate specimens were analyzed according to the clinical and laboratory standard institute instructions in the hospital's microbiology laboratory. Demographics, clinical, microbiological and laboratory findings were collected for each patient during the treatment course. Therapeutic empirical regimen, change in antibiotic regimen following receiving antibiogram results, clinical and microbiological responses, duration of ICU stay and outcome were collected for each recruited individual.


RESULTS
All ofA. baumaniiisolates were resistant to pipracillin-tazobactam, ceftriaxon, amikacin and ciprofloxacin. The resistance rate ofA. baumaniispecies was 41.4% for ampicillin/sulbactabm and 93.1% for meropenem. Patients received either meropenem/colistin (51.7%) or meropenem/ampicillin-sulbactam (48.3%) as the treatment regimens based on the antimicrobial susceptibility patterns of isolates. Ventilator-associated pneumonia clinical response, improvement and failure achieved in 15 (51.7%), 8 (27.6%) and 6 (20.7%) of the patients respectively. Microbiological eradication and intermediate status were observed in 9/29 (31%) and 11/29 (37.9%) of patients, respectively.


CONCLUSIONS
The antibiotic regimens showed comparable efficacy in treatment of VAP due to MDRA. baumanniibut mortality rate was high. Considering widespread and high mortality rates associated with MDR infections, applying infection control and antibiotic stewardship programs in hospitals are essential.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Lida
L
Shojaei
Department of Intensive Care Unit, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mostafa
M
Mohammadi
Department of Intensive Care Unit, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad-Taghi
MT
Beigmohammadi
Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Mahsa
M
Doomanlou
Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran.
Alireza
A
Abdollahi
Department of Medical Microbiology, Tehran University of Medical Sciences, Tehran, Iran; Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Mehdi
MM
Feizabadi
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Hossein
H
Khalili
Acinetobacter baumannii; Antibiotic therapy; Clinical response; Pneumonia