Antibiotherapy and Mortality Rate in Ventilator-Associated Pneumonia and Tracheobronchitis due to Acinetobacter Baumannii

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

Acinetobacter baumanii’ye bağlı Trakeobronşit ve Pnömonide Antibiyoterapi ve Mortalite Oranı

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

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Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

1.4b523

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