Influence of severity of infection on the effect of appropriate antimicrobial therapy forAcinetobacter baumanniibacteremic pneumonia

被引:5
作者
Kang, Fang-Yu [1 ]
How, Chorng-Kuang [1 ,2 ]
Wang, Yung-Chih [3 ]
Cheng, Aristine [4 ,5 ]
Yang, Ya-Sung [3 ,6 ]
Kuo, Shu-Chen [6 ]
Liu, Chang-Pan [7 ,8 ]
Liu, Yuag-Meng [9 ]
Chen, Te-Li [10 ,11 ]
Lee, Yi-Tzu [1 ,2 ]
机构
[1] Taipei Vet Gen Hosp, Dept Emergency Med, 201,Sect 2,Shipai Rd, Taipei 11217, Taiwan
[2] Natl Yang Ming Univ, Sch Med, Fac Med, Taipei, Taiwan
[3] Natl Def Med Ctr, Triserv Gen Hosp, Dept Internal Med, Div Infect Dis & Trop Med, Taipei, Taiwan
[4] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei, Taiwan
[5] Natl Taiwan Univ, Coll Med, Taipei, Taiwan
[6] Natl Hlth Res Inst, Natl Inst Infect Dis & Vaccinol, Zhunan Township, Miaoli County, Taiwan
[7] Mackay Mem Hosp, Dept Internal Med, Div Infect Dis, Taipei, Taiwan
[8] Mackay Mem Hosp, Dept Med Res, Taipei, Taiwan
[9] Changhua Christian Hosp, Div Infect Dis, Dept Internal Med, Changhua, Taiwan
[10] Natl Def Med Ctr, Grad Inst Life Sci, Taipei, Taiwan
[11] Taipei Vet Gen Hosp, Dept Med, Div Infect Dis, Taipei, Taiwan
关键词
Appropriate antimicrobial therapy; Acinetobacter baumannii; Bacteremia; Pneumonia; Severity; ACINETOBACTER-BAUMANNII BACTEREMIA; VENTILATOR-ASSOCIATED PNEUMONIA; HOSPITAL-ACQUIRED PNEUMONIA; RISK-FACTORS; ATTRIBUTABLE MORTALITY; NOSOCOMIAL PNEUMONIA; TIGECYCLINE; COLISTIN; IMPACT; MULTICENTER;
D O I
10.1186/s13756-020-00824-4
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background The impact of appropriate antimicrobial therapy forA. baumanniibacteremic pneumonia has not been well established due to the inclusion of the three phenotypically indistinguishableAcinetobacterspecies and confounding factors including underlying diseases and severity of infection. This retrospective study aimed to evaluate the impact of appropriate antimicrobial therapy on 14-day mortality inA. baumanniibacteremic pneumonia patients after adjusting for risk factors. Methods This study was conducted at five medical centers in Taiwan between July 2012 and June 2016.A. baumanniispecies identification was performed using reference molecular methods. Risk factors for 14-day mortality were analyzed via logistic regression. The interaction between the Acute Physiology and Chronic Health Evaluation (APACHE) II score and appropriate antimicrobial therapy was assessed using the logistic model. Results A total of 336 patients with monomicrobialA. baumanniibacteremic pneumonia were included in this study. The overall 14-day mortality rate was 47.3%. The crude mortality of appropriate antimicrobial therapy was 35.9% (57 of 151 patients). Appropriate antimicrobial therapy was associated with a lower mortality after multivariate adjustment (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.34-0.97;p = 0.04), and the effect was influenced by APACHE II score (OR for interaction term, 0.0098; 95% CI, 0.0005-0.1885;p = 0.002). Further analysis demonstrated that appropriate antimicrobial therapy significantly reduced 14-day mortality among the patients with an APACHE II score > 35 (OR 0.0098; 95% CI 0.0005-0.1885). Conclusion Appropriate antimicrobial therapy decreases 14-day mortality of the most severely ill patients withA. baumanniibacteremic pneumonia.
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页数:11
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共 38 条
  • [1] Incidence, risk factors and mortality of nosocomial pneumonia in intensive care units: A prospective study
    Alp E.
    Güven M.
    Yildiz O.
    Aygen B.
    Voss A.
    Doganay M.
    [J]. Annals of Clinical Microbiology and Antimicrobials, 3 (1)
  • [2] Frequentist and Bayesian Pharmacometric-Based Approaches To Facilitate Critically Needed New Antibiotic Development: Overcoming Lies, Damn Lies, and Statistics
    Ambrose, Paul G.
    Hammel, Jeffrey P.
    Bhavnani, Sujata M.
    Rubino, Christopher M.
    Ellis-Grosse, Evelyn J.
    Drusano, George L.
    [J]. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2012, 56 (03) : 1466 - 1470
  • [3] Pharmacological and Patient-Specific Response Determinants in Patients with Hospital-Acquired Pneumonia Treated with Tigecycline
    Bhavnani, Sujata M.
    Rubino, Christopher M.
    Hammel, Jeffrey P.
    Forrest, Alan
    Dartois, Nathalie
    Cooper, C. Angel
    Korth-Bradley, Joan
    Ambrose, Paul G.
    [J]. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2012, 56 (02) : 1065 - 1072
  • [4] Tigecycline MIC testing by broth dilution requires use of fresh medium or addition of the biocatalytic oxygen-reducing reagent Oxyrase to standardize the test method
    Bradford, PA
    Petersen, PJ
    Young, M
    Jones, CH
    Tischler, M
    O'Connell, J
    [J]. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2005, 49 (09) : 3903 - 3909
  • [5] Multidrug Resistance Acinetobacter Bacteremia Secondary to Ventilator-Associated Pneumonia: Risk Factors and Outcome
    Brotfain, Evgeni
    Borer, Abraham
    Koyfman, Leonid
    Saidel-Odes, Lisa
    Frenkel, Amit
    Gruenbaum, Shaun E.
    Rosenzweig, Vsevolod
    Zlotnik, Alexander
    Klein, Moti
    [J]. JOURNAL OF INTENSIVE CARE MEDICINE, 2017, 32 (09) : 528 - 534
  • [6] Mortality risk factors in patients with Acinetobacter baumannii ventilator-associated pneumonia
    Chang, Huang-Chih
    Chen, Yung-Che
    Lin, Meng-Chih
    Liu, Shih-Feng
    Chung, Yu-Hsiu
    Su, Mao-Chang
    Fang, Wen-Feng
    Tseng, Chia-Chen
    Lie, Chien-Hao
    Huang, Kuo-Tung
    Wang, Chin-Chou
    [J]. JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION, 2011, 110 (09) : 564 - 571
  • [7] Chen Hsin-Pai, 2005, Journal of Microbiology Immunology and Infection, V38, P127
  • [8] Comparison of one-tube multiplex PCR, automated ribotyping and intergenic spacer (ITS) sequencing for rapid identification of Acinetobacter baumannii
    Chen, T.-L.
    Siu, L.-K.
    Wu, R. C.-C.
    Shaio, M.-F.
    Huang, L.-Y.
    Fung, C.-P.
    Lee, C.-M.
    Cho, W.-L.
    [J]. CLINICAL MICROBIOLOGY AND INFECTION, 2007, 13 (08) : 801 - 806
  • [9] Excess Mortality Associated With Colistin-Tigecycline Compared With Colistin-Carbapenem Combination Therapy for Extensively Drug-Resistant Acinetobacter baumannii Bacteremia: A Multicenter Prospective Observational Study
    Cheng, Aristine
    Chuang, Yu-Chung
    Sun, Hsin-Yun
    Sheng, Wang-Huei
    Yang, Chia-Jui
    Liao, Chun-Hsing
    Hsueh, Po-Ren
    Yang, Jia-Ling
    Shen, Ni-Jiin
    Wang, Jann-Tay
    Hung, Chien-Ching
    Chen, Yee-Chun
    Chang, Shan-Chwen
    [J]. CRITICAL CARE MEDICINE, 2015, 43 (06) : 1194 - 1204
  • [10] Effectiveness of tigecycline-based versus colistin-based therapy for treatment of pneumonia caused by multidrug-resistant Acinetobacter baumannii in a critical setting: a matched cohort analysis
    Chuang, Yu-Chung
    Cheng, Chien-Yu
    Sheng, Wang-Huei
    Sun, Hsin-Yun
    Wang, Jann-Tay
    Chen, Yee-Chun
    Chang, Shan-Chwen
    [J]. BMC INFECTIOUS DISEASES, 2014, 14