Acinetobacter baumannii infections in intensive care units patients: predictors of risk factors of multidrug resistance
Abstract number: P1305
Acar A., Oncul O., Ozyurt M., Budak S., Gorenek L., Haznedaroglu T.
Objective: This study was designed to evaluate the incidence, epidemiologic and clinical features and outcome of patients of Acinetobacter related nosocomial infections in our intensive carte units, and to identify predictors of multi drug resistance (MDR) for Acinetobacter baumannii.
Methods: Prospective study of all patients with nosocomial A. baumannii infections in ICU from January 1, 2007 to December 31, 2008. MDR in A. baumannii was defined as resistance to at least three classes antibiotics (antipseudomonal penicillins, antipseudomonal cephalosporins, antipseudomonal flouroquinolones, aminogllycosides, or trimethoprim-sulfamethoxazole) but susceptibility to carbapenems, and non-MDR was defined as suspectibility to carbapenems and other alternative antipseudomonal antimicrobial agents (eg, penicilins, cephalosporins, fluoroquinolones, or aminoglycoside).
Results: Among the 147 ICU patients, 197 A. baumannii infections were developed. Their mean age was 57.04±25.8 years. Infections site were: bloodstream 40.6%, respiratory tract 28.4%, and burn wounds 14.5%. Congestive heart failure (40.3%), cerebrovascular illness and diabetes mellitus (24%) were the most common underlying disease. Mortality was 56.7%. Of 197 episodes of Acinetobacter infections, 168 (85.3%) caused by MDR strains were identified. The most effective antibacterial agents for A. baumannii were netilmicin (61.4%), doxycycline (60.8%) and tobramycin (59.6%) respectively. Congestive cardiac failure (p = 0.03), chronic obstructive lung disease (p = 0.02), diabetes mellitus (p = 0.04), previous antibiotic usage in last three months (p = 0.04), steroid usage (p = 0.03), dopamine usage (p < 0.001), and previous emergence of E. coli infections (p = 0.03) were risk factors for multi drug resistance in univariate analysis. Multivariate analysis showed that steroid usage (p = 0.91; odds ratio [OR], 4.7; 95% confidence interval [CI], 1.416.4) and previous emergence of E. coli infections (p = 0.004; OR, 6.4; 95% CI, 1.821.2) as independent predictors of MDR.
Conclusion:A. baumannii infections in ICU patients are associated high mortality and MDR. Avoidance of unnecessary antibiotics and steroid is high priority and specific attention should be paid to patients with infections Gram-negative enteric pathogens especially E. coli.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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