Objective: Ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii (A. baumannii) has a high mortality rate in the intensive care unit (ICU). The guidelines recommend empirical antimicrobial therapy in cases of VAP; however, similar treatment is not recommended in cases of ventilator-associated tracheobronchitis (VAT) with a culture result of A. baumannii. The aim of this study was to evaluate the difference in the ICU and long-term mortality of patients with A. baumannii VAP and VAT who were treated with antibiotherapy. Methods: This was a retrospective cohort study. Patients who were intubated in the respiratory ICU due to acute respiratory failure (ARF) and developed A. baumannii-associated VAP or VAT between January 2015 and January 2016 were included in this study. Demographic features, comorbidities, cause of ARF, arterial blood gas values, oxygenation level, chest X-ray findings, ICU severity scores (Sequential Organ Failure Assessment [SOFA] score, Charlson Comorbidity Index score, Acute Physiology and Chronic Health Evaluation II score), culture antibiotic susceptibility results, antibiotic regimen, length of ICU stay, and mortality details were recorded. Long-term mortality (1-, 2-, 3-, 12-month) details were obtained from national death records. The Kaplan-Meier method was used for long-term survival analysis. Results: Among 503 consecutive patients intubated between January 2015 and January 2016, 78 (15.5%) who had A. baumannii-associated VAT and VAP were included. Of the 78 patients, 21 (35%) were cases of VAP and 50 (65%) were cases of VAT. Diagnoses of the 78 patients were 62% chronic obstructive pulmonary disease, 15% pneumonia, 10% acute cardiogenic pulmonary edema, 9% lung cancer, and 4% kyphoscoliosis. Among the VAP patients, 21 (75%) were male and 7 (25%) were female, while among the VAT patients, 38 (76%) were male and 12 (24%) were female. There was no statically significant difference between the VAP and VAT patients according to age, gender, comorbidities, the presence of acute respiratory distress syndrome or septic shock, Charlson and SOFA scores, or length of hospital and ICU stay. The median (quartile ratio) duration of mechanical ventilator use was 15 days (7–22 days) for VAP patients and 12 days (6–14 days) for VAT patients (p=0.649). The ICU mortality rate was 68% among VAP patients and 40% among VAT patients (p
Amaç: Yoğun bakım ünitesinde (YBÜ) Acinetobacter baumanii’ye (A. baumanii) bağlı gelişen ventilatör ilişkili pnömonide (VİP) mortalite yüksektir. VİP’te ampirik antimikrobiyal tedavinin önemi rehberler tarafından vurgulanırken ventilatör ilişkili trakeobronşitte (VİT) ise tedavi tarışmalıdır. Çalışmamızda antimikrobiyal tedavi verilen VİT olgularında YBÜ ve uzun dönem mortalite oranlarının VİP olgularından farklı olup olmadığı araştırıldı. Gereç ve Yöntem: Çalışma, geriye dönük gözlemsel kohort metodu ile 23 yataklı 3. düzey solunumsal yoğun bakım ünitesinde yapıldı. Ocak 2015–Ocak 2016 arasında YBÜ’ye akut solunum yetersizliği (ASY) ile kabul edilen ve entübe olan A. baumannii etkenli VİT ve VİP gelişen hastalar çalışmaya alındı. Olguların demografik özellikleri, ek hastalıkları, ASY nedenleri, arter kan gazı değerleri, PaO2 /FiO2 , radyoloji, YBÜ ciddiyet skorları (SOFA, Charlson, APACHE II), kültür antibiyogram sonuçları, tedavileri, YBÜ kalış günü, mortaliteleri (YBÜ, 1, 2, 3 ve 12 aylık) ölüm bildirim sisteminden kayıt edildi. Sağ kalım analizi için Kaplan-Meier testi kullanıldı. Bulgular: Çalışmaya 503 entübe hastada kabul kriterleri olan A. baumanii etkenli VİP ve VİT 78 olgu (%15.5) dahil edildi, Olguların %62’si KOAH, %15’i pnömoni, %10’nu akut kardiyojenik ödem, %9’u akciğer kanseri, %4 kifoskolyoz tanılı idi. VİP ve VİT sayıları sırasıyla 28 (%35) ve 50 (%65) iken her iki grupta benzer şekilde erkek cinsiyeti daha fazla saptandı (sırasıyla %75, %76). Yaş, ek hastalık, yatış tanıları, Charlson, SOFA ve APACHE skorları, YBÜ ve hastane kalış süreleri gruplarda benzer idi. Mekanik ventilatörde ortanca (çeyrekler arası oran [ÇAO]) kalma süresi VİP ve VİT’de sırasıyla 15 (7–22) ve 12 (6–14) gün idi (p=0.649). YBÜ mortalitesi VİP ve VİT’de sırasıyla %68 ve %40 idi (p
1. Pingleton SK. Invasive mechanical ventilation in exacerbations of chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 1998;53:337–42.
2. Abou-Shala N, Meduri U. Noninvasive mechanical ventilation in patients with acute respiratory failure. Crit Care Med 1996;24:705–15.
3. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.
4. Torres A, Ferrer M, Badia JR. Treatment guidelines and outcomes of hospital-acquired and ventilator-associated pneumonia. Clin Infect Dis 2010;51:48–53.
5. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care 2014;18:208.
6. Alp E, Kiran B, Altun D, Kalin G, Coskun R, Sungur M, et al. Changing pattern of antibiotic susceptibility in intensive care units: ten years experience of a university hospital. Anaerobe 2011;17:422–5.
7. El-Saed A, Balkhy HH, Alansari H, Althaqafi, Alsalman J, Maskari ZAI, et al. Rates of ventilator-associated pneumonia in critical care units in three Arabian Gulf countries; six-year surveillance study. Antimicrob Resist Infect Control. 2015;4:245.
8. Kalin G, Alp E, Akin A, Coskun R, Doganay M. Comparison of colistin and colistin/sulbactam for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia. Infection 2014;42:37–42.
9. Nhu NTK, Lan NPH, Campbell JI, Parry CM1, Thompson C, Tuyen HT, et al. Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam. J Med Microbiol 2014;63:1386–1394.
10. Aşık G. Current approaches to explain the virulence of Acinetobacter baumannii. Mikrobiyol Bul 2011;45:371–380.
11. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.
12. Agrafiotis M, Siempos II, Falagas ME. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis. Respir Med 2010;104:325–36.
13. Nseir S, Ader F, Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis 2009;22:148–53.
14. Nseir S, Martin-Loeches I, Makris D, Jaillette E, Karvouniaris M, Valles J, et al. Impact of appropriate antimicrobial treatment on transition from ventilator-associated tracheobronchitis to ventilator-associated pneumonia. Crit Care 2014;18:R129.
15. Craven DE, Lei Y, Ruthazer R, Sarwar A, Hudcova J. Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia. Am J Med 2013;126:542–9.
16. Nseir S, Di Pompeo C, Pronnier P, Beague S, Onimus T, Saulnier F, et al. Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome. Eur Respir J 2002;20:1483– 9.
17. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63:61–111.
18. Nseir S, Favory R, Jozefowicz E, Decamps F, Dewavrin F, Brunin G, et al. Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study. Crit Care 2008;12:R62.
19. Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012;38:1930–45.
20. Martin-Loeches I, Povoa P, Rodríguez A, Curcio D, Suarez D, Mira JP, et al. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 2015;3:859–68.
21. Fujitani S, Cohen-Melamed MH, Tuttle RP, Delgado E, Taira Y, Darby JM. Comparison of semi-quantitative endotracheal aspirates to quantitative non-bronchoscopic bronchoalveolar lavage in diagnosing ventilator-associated pneumonia. Respir Care 2009;54:1453–61.
22. Nseir S, Di Pompeo C, Soubrier S, Delour P, Onimus T, Saulnier F. Outcomes of ventilated COPD patients with nosocomial tracheobronchitis: a case-control study. Infection 2004;32:210–6.
23. Karvouniaris M, Makris D, Manoulakas E, Zygoulis P, Mantzarlis K, Triantaris A, et al. Ventilator-associated tracheobronchitis increases the length of intensive care unit stay. Infect Control Hosp Epidemiol 2013;34:800–8.
24. Roquilly A, Mahe PJ, Seguin P, Guitton C, Floch H, Tellier AC, et al. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. JAMA 2011;305:1201–9.
25. Ruiz M, Torres A, Ewig S, Marcos MA, Alcón A, Lledó R, et al. Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome. Am J Respir Crit Care Med 2000;162:119–25.
26. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Me. 2006;34:1589–96.
27. Al-Omari A, Mohammed M, Alhazzani W, Al-Dorzi HM, Belal MS, Albshabshe AO, et al. Treatment of ventilator-associated pneumonia and ventilator-associated tracheobronchitis in the intensive care unit. A national survey of clinicians and pharmacists in Saudi Arabia. Saudi Med J 2015;36:1453–62.
28. Korbila IP, Michalopoulos A, Rafailidis PI, Nikita D, Samonis G, Falagas ME. Inhaled colistin as adjunctive therapy to intravenous colistin for the treatment of microbiologically documented ventilatorassociated pneumonia: a comparative cohort study. Clin Microbiol Infect 2010;16:1230–6.
29. Rattanaumpawan P, Lorsutthitham J, Ungprasert P, Angkasekwinai N, Thamlikitkul V. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother 2010;65:2645–9.