Acinetobacter baumannii ventilator-associated pneumonia: epidemiology, clinical characteristics, and prognosis factors

Chaari, Anis; Mnif, Basma; Bahloul, Mabrouk; Mahjoubi, Faouzia; Chtara, Kamilia; Turki, Olfa; Gharbi, Nourhene; Chelly, Hédi; Hammami, Adnène; Bouaziz, Mounir

doi:10.1016/j.ijid.2013.07.014

Cited by 57 publications

(47 citation statements)

References 21 publications

(25 reference statements)

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“…These are in-keeping with previous studies (6,9,10,12,13). Underlying diseases, including malignancy, renal disease, immunocompromised status, and hepatic disease, have also been reported as prognostic indicators of hospital mortality (4,10,(14)(15)(16). These factors were identified by univariate analysis in our study; however, malignancy was the only independent predictor of mortality identified following multivariate analysis.…”

Section: Discussionsupporting

confidence: 92%

Ventilator-Associated Pneumonia: Epidemiology and Prognostic Indicators of 30-Day Mortality

et al. 2015

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SUMMARY:We conducted a retrospective cohort study in the medical intensive care unit of Chaing Mai University Hospital to describe the epidemiology of ventilator-associated pneumonia (VAP) and identify prognostic indicators of 30-day VAP mortality. A total of 621 patients diagnosed with VAP between January 2005 and December 2011 were included. The overall 30-day mortality rate was 44.4z. The major causative pathogens were Acinetobacter baumannii (54.3z), Pseudomonas aeruginosa (35.2z), and methicillin-resistant Staphylococcus aureus (15.1z). Most A. baumannii (90.2z) comprised drug-resistant strains. Identified prognostic indicators were co-morbid malignancy (hazard ratio [HR] ＝ 1.60; 95z confidence interval [CI] 1.02-2.42; P ＝ 0.040), septic shock (HR ＝ 2.51; 95z CI, 1.60-4.00; P ＜ 0.001), Simplified Acute Physiology Score II ＞45 (HR ＝ 1.62; 95z CI, 1.03-2.56; P ＝ 0.041), Sequential Organ Failure Assessment score ＞5 (HR ＝ 3.40; 95z CI 2.00-5.81; P ＜ 0.001), and delayed inappropriate empirical antibiotic treatment (HR ＝ 2.23; 95z CI, 1.12-4.45; P ＝ 0.022). VAP was associated with high mortality. The major causative pathogen was drug-resistant A. baumannii. Therefore, early detection of VAP by surveillance in mechanically ventilated patients leading to earlier treatment may improve patient outcomes. Guidelines for prescribing appropriate empirical antibiotics to cover drug-resistant bacteria could be established using local epidemiological data.

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Section: Discussionsupporting

confidence: 92%

Ventilator-Associated Pneumonia: Epidemiology and Prognostic Indicators of 30-Day Mortality

et al. 2015

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“…It is associated with a high mortality rate, reaching up to 33% -50% in high-risk hospital wards, such as intensive care units (ICUs) (1). Acinetobacter baumannii constitutes the ninth most common nosocomial pathogen, reported by the national healthcare safety network (2).…”

Section: Introductionmentioning

confidence: 99%

“…Acinetobacter baumannii constitutes the ninth most common nosocomial pathogen, reported by the national healthcare safety network (2). It is a bacterium characterized by rapid development of resistance to the majority of antimicrobials and is associated with lower respiratory tract infections in critically ill patients (1,(3)(4)(5). This pathogen is responsible for nearly 5% -10% of VAP cases in ICUs and 61% of VAP-associated mortality in these settings (1,6).…”

Section: Introductionmentioning

confidence: 99%

“…It is a bacterium characterized by rapid development of resistance to the majority of antimicrobials and is associated with lower respiratory tract infections in critically ill patients (1,(3)(4)(5). This pathogen is responsible for nearly 5% -10% of VAP cases in ICUs and 61% of VAP-associated mortality in these settings (1,6). The most common concern among clinicians is the intrinsic resistance of A. baumannii isolates to common antibiotics used for pneumonia treatment (7).…”

Section: Introductionmentioning

confidence: 99%

“…The most common concern among clinicians is the intrinsic resistance of A. baumannii isolates to common antibiotics used for pneumonia treatment (7). Although several outbreaks have been reported in European countries, A. baumannii is known to be endemic to North Africa and Middle East countries including Iran (1,8). The mechanism of drug resistance acquisition in A. baumannii includes acquisition of mobile genetic elements, such as plasmids, Copyright transposons, and integrons from the surroundings (4,9).…”

Section: Introductionmentioning

confidence: 99%

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Emergence of Extensively Drug Resistant Acinetobacter baumannii-Encoding Integrons and Extended-Spectrum Beta-Lactamase Genes Isolated from Ventilator-Associated Pneumonia Patients

Rezai

Rafiei

Ahangarkani

et al. 2017

Jundishapur J Microbiol

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Background: Acinetobacter baumannii has increasingly become one of the most common pathogens causing ventilator-associated pneumonia (VAP). Objectives: In the present study, we aimed to assess the presence of extended-spectrum beta-lactamase (ESBL) and integron genes in A. baumannii isolates from VAP patients in the intensive care units (ICUs) of 18 hospitals in North of Iran. Methods: All patients, who were ventilated for at least 48 hours, were assessed daily for VAP. The minimum inhibitory concentrations were determined according to the standard protocol by the clinical and laboratory standards institute (CLSI). ESBL-producing A. baumannii was detected, using the double-disk synergy test. ESBL-positive A. baumannii isolates were screened for CTX, VEB, GES, SHV, int1, and int2 genes, using polymerase chain reaction (PCR) amplification. Results: In total, 29 out of 205 patients with nosocomial infections, admitted to ICUs during 2014 -2015, showed VAP caused by ESBL-producing A. baumannii. A total of 19 (65.51%) strains were extensively drug resistant (XDR). As the findings revealed, the rates of imipenem and colistin resistance were 55.2% and 34.5%, respectively. The prevalence of CTX, VEB, and SHV genes in ESBL-producing A. baumannii was 34.5%, 17.2%, and 96.6%, respectively. Also, 79.3% of the isolates had class 1 integrons, while 10.3% contained class 2 integrons. Conclusions: Presence of integrons in A. baumannii has been considerably associated with ESBL genes. The high rate of SHV and int1 genes highlights the necessity of avoiding aminoglycosides for empirical therapy. Although colistin was the most sensitive antibiotic in XDR strains in our region, due to the presence of patients with A. baumannii in ICUs, colistin resistance screening should be performed before empirical therapy for VAP, even for those without prior exposure to this antibiotic.

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Opportunisitic Pathogens of Humans

Burkholder¹,

O’Riordan

2016

Advances in Environmental Microbiology

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Acinetobacter baumannii ventilator-associated pneumonia: epidemiology, clinical characteristics, and prognosis factors

Abstract: A. baumannii VAP is associated with a high mortality. Hemodynamic impairment is predictive of a poor outcome.

Cited by 57 publications

References 21 publications

Ventilator-Associated Pneumonia: Epidemiology and Prognostic Indicators of 30-Day Mortality

Ventilator-Associated Pneumonia: Epidemiology and Prognostic Indicators of 30-Day Mortality

Emergence of Extensively Drug Resistant Acinetobacter baumannii-Encoding Integrons and Extended-Spectrum Beta-Lactamase Genes Isolated from Ventilator-Associated Pneumonia Patients

Opportunisitic Pathogens of Humans

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