Journal List > Tuberc Respir Dis > v.60(2) > 1000914

Lee, Jo, and Kim: Clinical Characteristics of Intensive Care Unit Patients with Carbapenem Resistant Acinetobacter Baumannii Isolated from Sputum

Abstract

Background

Acinetobacter baumannii is an important pathogen associated with nosocomial infections in intensive care units, and is responsible for nosocomial pneumonia, UTI, bacteremia, etc. The main concern is that this pathogen is often resistant to many antimicrobial agents, particularly to carbapenem. This study compared the clinical those of ICU admitted patients with the carbapenem resistant A. baumannii isolated from the sputum with characteristics of patients with carbapenem sensitive A. baumannii.

Methods

A total of 49 patients with A. baumannii from a sputum culture who were admitted to the ICU from January to December 2003 were enrolled in this study. This study evaluated the demographic variables, mortality, APACHE II score, comorbidity, antibiotics used, hospital and ICU stay, Clinical Pulmonary Infection Score, and mechanical ventilation. A retrospective analysis was made by a review of the patients' medical records.

Results

Carbapenem sensitive and resistant A. baumannii was isolated from 23 patients and 26 patients respectively. Univariate analysis revealed renal disease, the use of carbapenem and aminoglycoside to be statistically significant factors for carbapenem resistance. Multivariate analysis revealed carbapenem use(p=0.024; OR, 8.17; CI 1.32 to 50.68) to be positively associated with carbapenem resistance, and aminoglycoside use(p=0.026; OR, 0.18; CI, 0.04 to 0.82) to be negatively associated with carbapenem resistance. There was no significant difference in mortality between the carbapenem sensitive and resistant group(30 vs 42%. P=0.39).

Conclusion

The occurrence of carbapenem resistant A. baumannii is positively associated with carbapenem use and negatively associated with aminoglycoside use. Carbapenem resistance in the sputum culture did not affect the mortality rate.

Figures and Tables

Table 1
Univariate analysis for risk factors of carbapenem sensitive A. baumannii group and carbapenem resistant A. baumannii group
trd-60-228-i001

⋆The data are the numbers (%) of patients unless otherwise indicated

APACHE, Acute Physiology and Chronic Health Evaluation

CPIS, Clinical Pulmonary Infection Score

Table 2
Multivariate analysis for risk factors of carbapenem resistant A. baumannii group
trd-60-228-i002

References

1. Zarrilli R, Crispino M, Bagattini M, Barretta E, Popolo AD, Triassi M, et al. Molecular epidemiology of sequential outbreaks of Acinetobacter baumannii in an Intensive Care Unit shows the emergence of carbapenem resistance. J Clin Microbiol. 2004. 42:946–953.
2. Maniatis AN, Pournaras S, Orkopoulou S, Tassios PT, Legakis NJ. Multiresistant Acinetobacter baumannii isolates in intensive care units in Greece. Clin Microbiol Infect. 2003. 9:547–553.
3. Cisneros JM, Rodriguez BJ. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect. 2002. 8:687–693.
4. Looveren MV, Goossens H. Antimicrobial resistance of Acinetobacter spp. in Europe. Clin Microbiol Infect. 2004. 10:684–670.
5. Higgins PG, Wisplinghoff H, Stefanik D, Seifert H. In Vitro Activities of the β-Lactamase Inhibitors Clavulanic Acid, Sulbactam, and Tazobactam Alone or in Combination with β-Lactams against Epidemiologically Characterized Multidrug-Resistant Acinetobacter baumannii Strains. Antimicrob Agents Chemother. 2004. 48:1586–1592.
6. Turner PJ, Greenhalgh JM. The activity of meropenem and comparators against Acinetobacter strains isolated from European hospitals, 1997-2000. Clin Microbiol Infect. 2003. 9:563–567.
7. Choi JY, Park YS, Cho CH, Park YS, Shin SY, Song YG, et al. Synergic in-vitro activity of imipenem and sulbactam against Acinetobacter baumannii. Clin Microbiol Infect. 2004. 10:1098–1101.
8. Levin AS. Multiresistant Acinetobacter infections: a role for sulbactam combinations in overcoming an emerging worldwide problem. Clin Microbiol Infect. 2002. 8:144–153.
9. Corbella X, Montero A, Pujol M, Dominguez MA, Ayats J, Agrerich MJ, et al. Emergence and Rapid Spread of Carbapenem Resistance during a Large and Sustained Hospital Outbreak of Multiresistant Acinetobacter baumannii. J Clin Microbiol. 2000. 38:4086–4095.
10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med. 1985. 13:818–829.
11. Lee JH, Cheon SC, Jung SH, Phyun LH, Jang MZ, Lee YG, et al. Clinical usefulness of Clinical Pulmonary Infection Score of ICU patients with Sputum Culture positive for Multi-drug resistant Acinetobacter baumannii. Tuberc Respir Dis. 2003. 55:579–588.
12. Paterson DL. Looking for Risk Factors for the Acquisition of Antibiotic Resistance: A 21st-Century Approach. Clin Infect Dis. 2002. 34:1564–1567.
13. Lee SO, Kim NJ, Choi SH, Kim TH, Chung JW, Woo JH, et al. Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: a case-control study. Antimicrob Agents Chemother. 2004. 48:224–228.
14. Mulin B, Talon D, Viel JF, Vincent C, Leprat R, Thouverez M. Risk factors for nosocomial colonization with multiresistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis. 1995. 14:569–576.
15. Scerpella EG, Wanger AR, Armitige L, Anderlini P, Ericsson CD. Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations. Infect Control Hosp Epidemiol. 1995. 16:92–97.
16. Husni RN, Goldstein LS, Arroliga AC, Hall GS, Fatica C, Stoller JK. Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest. 1999. 115:1378–1382.
17. Koeleman JG, Parlevliet GA, Dijkshoorn L, Savelkoul PH, Vandenbroucke-Grauls CM. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition. J Hosp Infect. 1997. 37:113–123.
18. Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis. 1995. 20:790–796.
19. Doi Y, Wachino JI, Yamane K, Shibata N, Yagi T, Shibayama K, et al. Spread of Novel Aminoglycoside Resistance Gene aac(6)-Iad among Acinetobacter Clinical Isolates in Japan. Antimicrob Agents Chemother. 2004. 48:2075–2080.
20. Over U, Gur D, Unal S, Miller GH. The changing nature of aminoglycoside resistance mechanisms and prevalence of newly recognized resistance mechanisms in Turkey. Clin Microbiol Infect. 2001. 7:470–478.
21. Gold HS, Moellering RC. Antimicrobial-drug resistance. N Engl J Med. 1996. 335:1445–1453.
22. Bernabeu-Wittel M, Pichardo C, Garcia-Curiel A, Pachon-Ibanez ME, Ibanez-Martinez J, Jimenez-Mejias ME, et al. Pharmacokinetic/pharmacodynamic assessment of the in-vivo efficacy of imipenem alone or in combination with amikacin for the treatment of experimental multiresistant Acinetobacter baumannii pneumonia. Clin Microbiol Infect. 2005. 11:319–325.
23. Garnacho J, Sole-Violan J, Sa-Borges M, Diaz E, Rello J. Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: A matched cohort study. Crit Care Med. 2003. 31:2478–2482.
24. Bregeon F, Ciais V, Carret V, Gregoire R, Saux P, Gainnier M. Is ventilator-associated pneumonia an independent risk factor for death? Anesthesiology. 2001. 94:554–560.
25. Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993. 94:281–288.
26. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002. 122:2115–2121.
27. Bercault N, Boulain T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med. 2001. 29:2303–2309.
28. Kollef MH. What is ventilator-associated pneumonia and why is it important? Respir Care. 2005. 50:714–724.
29. Del Mar Tomas M, Cartelle M, Pertega S, Beceiro A, Llinares P, Canle D. Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection. Clin Microbiol Infect. 2005. 11:540–546.
30. Michalopoulos AS, Tsiodras S, Rellos K, Mentzelopoulos S, Falagas ME. Colistin treatment in patients with ICU-acquired infections caused by multiresistant gram-negative bacteria: the renaissance of an old antibiotic. Clin Microbiol Infect. 2005. 11:115–121.
TOOLS
Similar articles