Clinical response and outcome of pneumonia due to multi-drug resistant Acinetobacter baumannii in critically ill patients
Shojaei، Lida نويسنده Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Shojaei, Lida , Mohammadi، Mostafa نويسنده Department of Electrical Engineering Amirkabir University of Technology , , Beigmohammadi، Mohammad Taghi نويسنده Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of medical Sciences, Tehran, Iran , , Doomanlou، Mahsa نويسنده MSc in Microbiology,Central Laboratory,Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Doomanlou, Mahsa , Abdollahi، Alireza نويسنده , , Feizabadi، Mohammad-Mehdi نويسنده Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran Feizabadi, Mohammad-Mehdi , Khalili، Hossein نويسنده ,
Background and Objectives: The frequency of multi-drug resistant Acinetobacter spp. infections is increasing in Iran. Considering availability of limited therapeutic options, clinical response and outcome of ventilator-associated pneumonia due to multi-drug resistant A.baumannii were evaluated in critically ill patients.
Materials and Methods: In this prospective study, 29 patients with carbapenem resistance A. baumannii ventilator-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 of A. baumanii isolates were resistant to pipracillin-tazobactam, ceftriaxon, amikacin and ciprofloxacin. The resistance rate of A. baumanii species 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
Conclusion: The antibiotic regimens showed comparable efficacy in treatment of VAP due to MDR A. baumannii but 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.