MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY INTENSIVE CARE UNIT

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MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY INTENSIVE CARE UNIT Pervin Korkmaz Ekren 1 , M. Sezai Tasbakan 1 , Burcu Basarık 1 , Husnu Pullukcu 2 , Sohret Aydemir 3 , Alev Gurgun 1 , Ozen Kacmaz Basoglu 1 , Feza Bacakoglu 1 niversity School of Medicine Departments of 1 Chest Diseases, 2 Infec se and Clinic Microbiology, 3 Microbiology and Clinic Microbiology

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MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY INTENSIVE CARE UNIT. Pervin Korkmaz Ekren 1 , M. Sezai Tasbakan 1 , Burcu Basarık 1 , Husnu Pullukcu 2 , Sohret Aydemir 3 , Alev Gurgun 1 , Ozen Kacmaz Basoglu 1 , Feza Bacakoglu 1. - PowerPoint PPT Presentation

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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

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