Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i>
Multidrug-resistant <i>A. baumannii</i> (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 th...
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| Format: | Article |
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MDPI AG
2022-07-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/7/892 |
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| author | Dalia Adukauskiene Ausra Ciginskiene Agne Adukauskaite Despoina Koulenti Jordi Rello |
| author_facet | Dalia Adukauskiene Ausra Ciginskiene Agne Adukauskaite Despoina Koulenti Jordi Rello |
| author_sort | Dalia Adukauskiene |
| collection | DOAJ |
| description | Multidrug-resistant <i>A. baumannii</i> (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 (<i>p</i> < 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 <i>A. baumannii</i> (57.3 vs. 36.4%). Monobacterial MDRAB VAP was associated (<i>p</i> < 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 (<i>p</i> < 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. |
| first_indexed | 2024-03-09T12:20:45Z |
| format | Article |
| id | doaj.art-4fd47569ed6e4011abd5551e7ed28caf |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T12:20:45Z |
| publishDate | 2022-07-01 |
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| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-4fd47569ed6e4011abd5551e7ed28caf2023-11-30T22:41:04ZengMDPI AGAntibiotics2079-63822022-07-0111789210.3390/antibiotics11070892Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i>Dalia Adukauskiene0Ausra Ciginskiene1Agne Adukauskaite2Despoina Koulenti3Jordi Rello4Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, LithuaniaMedical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, LithuaniaDepartment of Cardiology and Angiology, University Hospital of Innsbruck, 6020 Innsbruck, AustriaSecond Critical Care Department, Attikon University Hospital, 12462 Athens, GreeceVall d‘Hebron Institute of Research, Vall d‘Hebron Campus Hospital, 08035 Barcelona, SpainMultidrug-resistant <i>A. baumannii</i> (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 (<i>p</i> < 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 <i>A. baumannii</i> (57.3 vs. 36.4%). Monobacterial MDRAB VAP was associated (<i>p</i> < 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 (<i>p</i> < 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.https://www.mdpi.com/2079-6382/11/7/892<i>Acinetobacter baumannii</i>antibiotic optimisationantibiotic stewardship (AMS)aspiration pneumoniacolistinhospital-acquired pneumonia (HAP) |
| spellingShingle | Dalia Adukauskiene Ausra Ciginskiene Agne Adukauskaite Despoina Koulenti Jordi Rello Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i> Antibiotics <i>Acinetobacter baumannii</i> antibiotic optimisation antibiotic stewardship (AMS) aspiration pneumonia colistin hospital-acquired pneumonia (HAP) |
| title | Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i> |
| title_full | Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i> |
| title_fullStr | Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i> |
| title_full_unstemmed | Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i> |
| title_short | Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant <i>Acinetobacter baumannii</i> |
| title_sort | clinical features and outcomes of monobacterial and polybacterial episodes of ventilator associated pneumonia due to multidrug resistant i acinetobacter baumannii i |
| topic | <i>Acinetobacter baumannii</i> antibiotic optimisation antibiotic stewardship (AMS) aspiration pneumonia colistin hospital-acquired pneumonia (HAP) |
| url | https://www.mdpi.com/2079-6382/11/7/892 |
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