MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY INTENSIVE CARE UNIT
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Transcript of MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY INTENSIVE CARE UNIT
MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY
INTENSIVE CARE UNIT
Pervin Korkmaz Ekren1, M. Sezai Tasbakan1, Burcu Basarık1, Husnu Pullukcu2, Sohret Aydemir3, Alev Gurgun1, Ozen Kacmaz Basoglu1, Feza Bacakoglu1
Ege University School of Medicine Departments of 1 Chest Diseases, 2 Infection Disease and Clinic Microbiology, 3 Microbiology and Clinic Microbiology
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Nosocomial Infections (1) • Multidrug-resistant (MDR) Gram-negative bacilli !!!• Acinetobacter baumannii : - Developing of antimicrobial resistance is
extremely rapid
- This resistance is multiple
Serious therapeutic problems
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Nosocomial Infections (2)
Acinetobacter baumannii : - Bacteremia
- Urinary tract infection - Secondary meningitis
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Nosocomial Infections (2)
Acinetobacter baumannii : - Bacteremia
- Urinary tract infection - Secondary meningitis
- Nosocomial pneumonia
In intensive care
units (ICU)Role in ventilator-
associated pneumonia (VAP)↑
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Method
• Ege University, Department of Chest Diseases
• Respiratory ICU • December 2005 – December 2007• 218 patients 58 patients (26.6% )
• 37 patients included in this study
MDR A.baumanniInfection (-)
MDR A.baumanniInfection (+)
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Table 1. Severity of diseases and characteristics of patients with MDR A.baumannii infections
Age (men year±SD) 61.6 ±19.8
Gender (Male), n (%) 21 (%56.8)
DİAGNOSİS n, (%) CAP NP COPD PIP Lung TB OUAS ARDS Ampiema+pneumothorax Hemothorax Lung cancer
10 (% 27.0)10 (% 27.0) 8 (% 21.6)2 (% 5.4)2 (% 5.4)1 (% 2.7)1 (% 2.7)1 (% 2.7)1 (% 2.7)1 (% 2.7)
Co-morbidty (var - %) 81.1
İmmunsupreyon* (var - %) 21.6
During last month (%); Hospitalization Antimicrobial therapy
70.351.6
APACHE II (mean±SD) 20.6±6.9
PaO2/FiO2 (mean±SD) 213.1±89.5
Abbreviations: CAP= Community-acquired pneumoniae; NP= Nosocomial pneumoniae; COPD= Chronic obstructive lung disease; PIP= Pneumoniae at immunocompromised patients; TB= Tuberculosis; OSAS=Obstructive sleep apne syndrome; ARDS= “Acute respiratory distress syndrome”; APACHE II= “Acute Physiology and Chronic Health Evaluation”.*Causes of immunsuppresion: Haematological malignancy (4 cases), collagen vascular disease (2 cases), renal transplantation (1 case), renal failure (1 case)
Results-1
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• 31 patients ( 83.7 % ) Invasive mechanical ventilation
• Patients with MDR A.baumannii infections;
VAP (+)
VAP (- )
59.5 %
Pneumoniae 100 % of them
24.3 %
Results-2
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Figure 1. Rates of samples that MDR A.baumannii isolated
59,5
16,210,8 10,8
2,7
0102030405060708090
100
ETA Sputum FOB Blood Pleural
fluid
ETA
Sputum
FOB
Blood
Pleural fluid
(%)
Abbreviations: ETA= Endotracheal aspiration; FOB= Fiberoptic bronchoscopy.
Results-3
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Table 2. Clinical characteristics of patients at the time of the MDR A.baumannii infections
Pneumoniae days at ICU* 10.3±7.1
Temperature (>37.5 0C, %) Leukcyte count (/mm3)* CRP (mg/dl)* SIRS (%) Sepsis (%) ARDS (%)
48.613655±7429
12.3±8.464.945.918.9
Sings at Chest X-ray (%) Lobar infiltrates Bilateral infiltrates Pleural fluid
32.443.245.9
Organ Failures (%) Respiratory Cardiovasculer Renal
78.424.318.9
Abbreviations: ICU=İntensive care unit; VAP= ventilator-associated pneumonia; CRP= C-reaktive protein; SIRS= Systemic inflamatory response syndrome; ARDS= “Acute respiratory distress syndrome”.*mean±SD
Results-4
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Table 3. Risk factors at patients with MDR A.baumannii infections
Risk factors (%)
Re-intubation 59.5
Tracheostomy 21.6
Fiber Optic Bronchoscopy
48.6
Chest Tube 13.5
Catheterization 27.0
Enteral Feeding 56.7
Results-5
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Figure 2. Antibiotics that used at the time of MDR A.baumannii infections
31,2
28,1
21,8
18,7
12,5
0 10 20 30 40 50
Meropenem
Cefaperazon/sulbactam
Respiratory quinolones
Linezolide
Piperacillin/ tazobactam
(%)
Results-6
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(%)
Figure 3. Rates of antibiotic resistances for A.baumannii that isolated
Drug-resistance to all antibiotics was observed in 62.2% of patients
Results-7
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Figure 4. Use of antibiotics for MDR A.baumannii infections
(%)
Duration of antimicrobial therapy: 13.3± 6.7 days
Results-8
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Table 4. Characteristics, risk factors and prognosis of patients with/without MDR A.baumannii infections
MDR A.baumannii (+)37 patients
MDR A.baumannii (-)
181 patientsp value
Gender (Men), n (%) 21 (% 56.8) 115 (% 63.5) 0.46
Age (yrs)* 61.6±19.8 65.4 ±14.8 0.27
Re-intubation n, (%) 22 (% 59.5) 14 (% 7.7) 0.001
Tracheostomy n, (%) 8 (% 21.6) 7 (% 3.9) 0.001
Duration of (days)* ICU stay Hospital stay
24.2 ±18.333.3 ±19.8
8.21 ±8.315.4 ±11.4
<0.0001<0.0001
Mortality n, (%) 18 (% 48.6) 71 (% 39.2) 0.35
Abbreviatios: MDR= Multidrug resistant; ICU=Intensive care unit.* mean±SD
Results-9
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Discussion (1)
• Infections with A.baumannii in ICUs• Antibiotic resistance
• VİP due to MDR A.baumannii; antimicrobial therapy
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Discussion (2)
Pneumoniae with MDR A.baumannii - prognosis is similar
- durations of ICU and hospital stays are increasing
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Conclusions
• In the our respiratory ICU infections with MDR A.baumannii : % 26.6
Drug-resistance to all antibiotics was Observed in 62.2% of patients
% 59.5 VİP % 24.3 bacteraemia