Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia

Abstract

Objectives: To investigate the impact of imipenem resistance on the mortality rate among patients with Acinetobacter bacteraemia.Methods: A retrospective, pairwise-matched (1:1), risk-adjusted (age, Pitt bacteraemia score) cohort study was performed at three tertiary care hospitals in Korea from January 2000 to June 2005.Results: Forty patients with imipenem non-susceptible Acinetobacter bacteraemia (INAB group) and 40 matched subjects (1:1 ratio) with imipenem-susceptible Acinetobacter bacteraemia (ISAB group) were included. Both groups had similar clinical features related to the severity of illness. The 30 day mortality rate was higher in the INAB group (57.5%) than the ISAB group (27.5%) (P 5 0.007). The rate of discordant antimicrobial therapy was higher in the INAB group (65.0%) than the ISAB group (20.0%) (P < 0.001). The 30 day mortality rate was higher in the patients with discordant antimicrobial therapy (67.6%) than concordant antimicrobial therapy (23.9%) (P < 0.001). Multivariate analysis showed that age, the Pitt bacteraemia score, immunosuppressive status, and discordant antimicrobial therapy were independent risk factors for 30 day mortality among patients with Acinetobacter bacteraemia (P < 0.05). When discordant antimicrobial therapy was excluded in the multivariate analysis, the imipenem resistance was associated with 30 day mortality (P 5 0.005).Conclusions: Imipenem resistance has a significant impact on the mortality rate among patients with Acinetobacter bacteraemia, and this is mainly attributable to the higher rate of discordant antimicrobial therapy.

Clinical and microbiological characterization of carbapenem-resistant Acinetobacter baumannii bloodstream infections

“…Clinical manifestations of A. baumannii induced BIs ranged from self limiting, transient bacteraemia to fulminant disease with a high mortality (Seifert et al, 1995). The overall mortality rate of Acinetobacter bacteraemia has been reported to be high, ranging from 22 to 61.6 % according to the study population (Bergogne-Bérézin & Towner, 1996;Kwon et al, 2007;Wareham et al, 2008;Erbay et al, 2009;Metan et al, 2009). In this study, the overall mortality was 53.6 %, with rates of 30.8 and 73.3 % for patients who received appropriate and inappropriate antibiotic therapy within 48 h, respectively.…”

“…In order to analyse the production of class B and D carbapenemase, carbapenem-resistant isolates were first screened by a modified Hodge test and an imipenem-EDTA double disc synergy test (Lee et al, 2001). PCR was performed to detect bla OXA , bla IMP and bla VIM genes using specific primers as previously described (Song et al, 2007). The presence of the insertion element ISAba1 upstream of bla OXA-51 -like was also investigated by PCR (Turton et al, 2006).…”

Acinetobacter Main Cause of Hospital Acquired Infections: A Review

“…This property to resist approximately all common antibiotics set the mortality rate at a high level, i.e., 26-68% [26][27][28]. Acinetobacter infections and colonization are associated with increased mortality [29][30][31].…”

Successful control of outbreak caused by clonally related extensively-resistant Acinetobacter baumannii in an intensive care unit

“…Risk factors associated with the resistance acquisition mainly include injudicious and broad spectrum antibiotic exposure, prolonged stay in the ICUs, mechanical ventilation and drifting from local antibiogram based antibiotic policies [6]. Investigations of several outbreaks of resistant infections have been ascribed to direct contact [7]. We describe outbreak of A. baumannii that occurred in a newly commissioned ICU of a major operation theatre complex at a tertiary care hospital.…”