Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases

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Abstract

Background and objective:

Acinetobacter baumanniiandA. baumannii/calcoaceticuscomplex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms.

Methods:

The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia.

Results:

Of the subjects, 94.9% (n= 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49–4.56;P= 0.001), septic shock (OR, 6.12; 95% CI: 2.75–13.64;P< 0.001), APACHE II score ≥ 20 (OR, 2.12; 95% CI: 1.28–3.50;P= 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00–2.64;P= 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11–5.68;P= 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P< 0.001,P< 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)–46/123 (37.4%),P= 0.037 and 62/93 (66.7%)–65/123 (52.8%),P= 0.041, respectively) in pneumonia caused by imipenem-resistant strains.

Conclusion:

Mortality rates were high in pneumonia caused by imipenem-resistantA. baumanniiorA. baumannii/calcoaceticuscomplex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.

Conclusion:

This study aimed to retrospectively evaluate the treatment and prognostic risk factors in 356 subjects with nosocomial pneumonia caused byA. baumannii, which is the largest series reported to date.

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