Fernando da Silveira1, Wagner Luis Nedel2, Renato Cassol3, Patricia Reis Pereira3, Caroline Deutschendorf4, Thiago Lisboa5. 1. Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil. 2. Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil; Post-graduate program in Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Intensive Care Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil. Electronic address: wagnernedel@uol.com.br. 3. Infection Control Unit, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil. 4. Infection Control Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil. 5. Intensive Care Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil; Infection Control Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil.
Abstract
INTRODUCTION: Acinetobacter species treatment often represents a challenge. The main objective of this study is identify predictors of ICU mortality in patients submitted to mechanical ventilation (MV). MATERIALS AND METHODS: Retrospective cohort study. Patients with MV > 48 h who developed a respiratory tract positive culture for Acinetobacter were included, and distinguished among colonized, ventilator-associated pneumonia (VAP) or ventilator-associated tracheobronchitis (VAT) patients. Primary outcome was ICU mortality. RESULTS: 153 patients were in MV and presented positive culture for Acinetobacter calcoaceticus-baumanii complex, 70 of them with VAP, 59 with VAT and 24 patients were colonized. The factors related to ICU mortality were VAP (OR 2.2, 95% CI 1.1-4.5) and shock at the time of diagnosis (OR 4.8, 95% CI 1.8-2.3). In multivariate analysis, only SOFA score at the time of diagnosis (OR 1.06, 95% CI 1.03-1.09) was related with ICU mortality. A paired-matched analysis was performed to assess effect of dual therapy on outcomes, and no effect was found in terms of clinical cure, ICU or hospital mortality or duration of antimicrobial therapy. CONCLUSIONS: Previous comorbidities and degree of associated organic injury seem to be more important factors in the prognosis than double antibiotic therapy in patients with Acinetobacter-related respiratory infection.
INTRODUCTION:Acinetobacter species treatment often represents a challenge. The main objective of this study is identify predictors of ICU mortality in patients submitted to mechanical ventilation (MV). MATERIALS AND METHODS: Retrospective cohort study. Patients with MV > 48 h who developed a respiratory tract positive culture for Acinetobacter were included, and distinguished among colonized, ventilator-associated pneumonia (VAP) or ventilator-associated tracheobronchitis (VAT) patients. Primary outcome was ICU mortality. RESULTS: 153 patients were in MV and presented positive culture for Acinetobacter calcoaceticus-baumanii complex, 70 of them with VAP, 59 with VAT and 24 patients were colonized. The factors related to ICU mortality were VAP (OR 2.2, 95% CI 1.1-4.5) and shock at the time of diagnosis (OR 4.8, 95% CI 1.8-2.3). In multivariate analysis, only SOFA score at the time of diagnosis (OR 1.06, 95% CI 1.03-1.09) was related with ICU mortality. A paired-matched analysis was performed to assess effect of dual therapy on outcomes, and no effect was found in terms of clinical cure, ICU or hospital mortality or duration of antimicrobial therapy. CONCLUSIONS: Previous comorbidities and degree of associated organic injury seem to be more important factors in the prognosis than double antibiotic therapy in patients with Acinetobacter-related respiratory infection.
Authors: Samar S Mabrouk; Ghada R Abdellatif; Mona R El-Ansary; Khaled M Aboshanab; Yasser M Ragab Journal: Infect Drug Resist Date: 2020-09-11 Impact factor: 4.003