Sistema de Salut de Catalunya
Institut Català de la Salut
[Adukauskiene D, Ciginskiene A] Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. [Adukauskaite A] Department of Cardiology and Angiology, University Hospital of Innsbruck, Innsbruck, Austria. [Koulenti D] Second Critical Care Department, Attikon University Hospital, Athens, Greece. UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The Univesrity of Queensland, Brisbane, Australia. [Rello J] Vall d‘Hebron Institut de Recerca (VHIR), Barcelona, Spain. Clinical Research, CHU Nîmes, Nîmes, France
Vall d'Hebron Barcelona Hospital Campus
2022-10-11T08:38:13Z
2022-10-11T08:38:13Z
2022-07-04
Aspiration pneumonia; Multidrug-resistance; Polymicrobial
Neumonía por aspiración; Resistencia a múltiples fármacos; Polimicrobiano
Pneumònia per aspiració; Resistència a múltiples fàrmacs; Polimicrobiana
Multidrug-resistant A. baumannii (MDRAB) VAP has high morbidity and mortality, and the rates are constantly increasing globally. Mono- and polybacterial MDRAB VAP might differ, including outcomes. We conducted a single-center, retrospective (January 2014–December 2016) study in the four ICUs (12–18–24 beds each) of a reference Lithuanian university hospital, aiming to compare the clinical features and the 30-day mortality of monobacterial and polybacterial MDRAB VAP episodes. A total of 156 MDRAB VAP episodes were analyzed: 105 (67.5%) were monomicrobial. The 30-day mortality was higher (p < 0.05) in monobacterial episodes: overall (57.1 vs. 37.3%), subgroup with appropriate antibiotic therapy (50.7 vs. 23.5%), and subgroup of XDR A. baumannii (57.3 vs. 36.4%). Monobacterial MDRAB VAP was associated (p < 0.05) with Charlson comorbidity index ≥3 (67.6 vs. 47.1%), respiratory comorbidities (19.0 vs. 5.9%), obesity (27.6 vs. 9.8%), prior hospitalization (58.1 vs. 31.4%), prior antibiotic therapy (99.0 vs. 92.2%), sepsis (88.6 vs. 76.5%), septic shock (51.9 vs. 34.6%), severe hypoxemia (23.8 vs. 7.8%), higher leukocyte count on VAP onset (median [IQR] 11.6 [8.4–16.6] vs. 10.9 [7.3–13.4]), and RRT need during ICU stay (37.1 vs. 17.6%). Patients with polybacterial VAP had a higher frequency of decreased level of consciousness (p < 0.05) on ICU admission (29.4 vs. 14.3%) and on VAP onset (29.4 vs. 11.4%). We concluded that monobacterial MDRAB VAP had different demographic/clinical characteristics compared to polybacterial and carried worse outcomes. These important findings need to be validated in a larger, prospective study, and the management implications to be further investigated.
Artículo
Versión publicada
Inglés
Acinetobàcter; Microorganismes - Resistència als medicaments; Pneumònia - Tractament; DISEASES::Bacterial Infections and Mycoses::Infection::Cross Infection::Pneumonia, Ventilator-Associated; PHENOMENA AND PROCESSES::Microbiological Phenomena::Bacterial Physiological Phenomena::Drug Resistance, Bacterial::Drug Resistance, Multiple, Bacterial; ORGANISMS::Bacteria::Gram-Negative Bacteria::Gram-Negative Aerobic Bacteria::Gram-Negative Aerobic Rods and Cocci::Moraxellaceae::Acinetobacter::Acinetobacter baumannii; ENFERMEDADES::infecciones bacterianas y micosis::infección::infección hospitalaria::neumonía asociada al ventilador; FENÓMENOS Y PROCESOS::fenómenos microbiológicos::fenómenos fisiológicos bacterianos::farmacorresistencia bacteriana::farmacorresistencia bacteriana múltiple; ORGANISMOS::Bacteria::bacterias gramnegativas::bacterias aerobias gramnegativas::bacilos y cocos aerobios gramnegativos::Moraxellaceae::Acinetobacter::Acinetobacter baumannii
MDPI
Antibiotics;11(7)
https://doi.org/10.3390/antibiotics11070892
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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