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Crit Care. 2016 Jul 11;20(1):221. doi: 10.1186/s13054-016-1392-4.

Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis.

Author information

1
EviMed Research Group, LLC, PO Box 303, Goshen, MA, 01032, USA. evimedgroup@gmail.com.
2
OptiStatim, LLC, Longmeadow, MA, USA.
3
The Medicines Company, Parsippany, NJ, USA.
4
Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.

Abstract

BACKGROUND:

The relationship between multidrug resistance (MDR), inappropriate empiric therapy (IET), and mortality among patients with Acinetobacter baumannii (AB) remains unclear. We examined it using a large U.S.

METHODS:

We conducted a retrospective cohort study using the Premier Research database (2009-2013) of 175 U.S. hospitals. We included all adult patients admitted with pneumonia or sepsis as their principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, along with antibiotic administration within 2 days of admission. Only culture-confirmed infections were included. Resistance to at least three classes of antibiotics defined multidrug-resistant AB (MDR-AB). We used logistic regression to compute the adjusted relative risk ratio (RRR) of patients with MDR-AB receiving IET and IET's impact on mortality.

RESULTS:

Among 1423 patients with AB infection, 1171 (82.3 %) had MDR-AB. Those with MDR-AB were older (63.7 ± 15.4 vs. 61.0 ± 16.9 years, p = 0.014). Although chronic disease burden did not differ between groups, the MDR-AB group had higher illness severity than those in the non-MDR-AB group (intensive care unit 68.0 % vs. 59.5 %, p < 0.001; mechanical ventilation 56.2 % vs. 42.1 %, p < 0.001). Patients with MDR-AB were more likely to receive IET than those in the non-MDR-AB group (76.2 % MDR-AB vs. 13.8 % non-MDR-AB, p < 0.001). In a regression model, MDR-AB strongly predicted receipt of IET (adjusted RRR 5.5, 95 % CI 4.0-7.7, p < 0.001). IET exposure was associated with higher hospital mortality (adjusted RRR 1.8, 95 % CI 1.4-2.3, p < 0.001).

CONCLUSIONS:

In this large U.S. database, the prevalence of MDR-AB among patients with AB infection was > 80 %. Harboring MDR-AB increased the risk of receiving IET more than fivefold, and IET nearly doubled hospital mortality.

KEYWORDS:

Acinetobacter baumannii; Inappropriate empiric therapy; Multidrug resistance; Outcomes; Pneumonia; Sepsis

PMID:
27417949
PMCID:
PMC4946176
DOI:
10.1186/s13054-016-1392-4
[Indexed for MEDLINE]
Free PMC Article

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