Prognostic factors associated with mortality of drug-resistant Acinetobacter baumannii ventilator-associated pneumonia

Research

Juthamas Inchai¹, Chaicharn Pothirat¹, Chaiwat Bumroongkit¹, Atikun Limsukon¹, Weerayut Khositsakulchai² and Chalerm Liwsrisakun^1*

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  Corresponding author: Chalerm Liwsrisakun [email protected]

Author Affiliations

¹ Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand

² Department of Medicine, Nakornping Hospital, Chiang Mai, Thailand

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Journal of Intensive Care 2015, 3:9 
doi:10.1186/s40560-015-0077-4

Published: 2 March 2015

Abstract (provisional)

Background Ventilator-associated pneumonia (VAP) caused by drug-resistant Acinetobacter
baumannii is associated with high mortality in critically ill patients. We identified
the prognostic factors of 30-day mortality in patients with VAP caused by drug-resistant
A. baumannii and compared survival outcomes among multidrug-resistant (MDR), extensively
drug-resistant (XDR) and pandrug-resistant (PDR) A. baumannii VAP. Methods A retrospective
cohort study was conducted in the Medical Intensive Care Unit at Chiang Mai University
Hospital, Thailand. All adult patients diagnosed with A. baumannii VAP between 2005
and 2011 were eligible. Univariable and multivariable Cox’s proportional hazards regression
were performed to identify the prognostic factors of 30-day mortality. Results A total
of 337 patients with microbiologically confirmed A. baumannii VAP were included. The
proportion of drug-sensitive (DS), MDR, XDR, and PDR A. baumannii were 9.8%, 21.4%,
65.3%, and 3.6%, respectively. The 30-day mortality rates were 21.2%, 31.9%, 56.8%,
and 66.7%, respectively. The independent prognostic factors were SOFA score gt;5
(hazard ratio (HR)?=?3.33, 95% confidence interval (CI) 1.94–5.72, P?lt;?0.001),
presence of septic shock (HR?=?2.66, 95% CI 1.71–4.12, P?lt;?0.001), Simplified Acute
Physiology Score (SAPS) II gt;45 (HR?=?1.58, 95% CI 1.01–2.46, P?=?0.045), and inappropriate
initial antibiotic treatment (HR?=?1.53, 95% CI 1.08–2.20, P?=?0.016). Conclusions
Drug-resistant A. baumannii, particularly XDR and PDR, was associated with a high
mortality rate. Septic shock, high SAPS II, high SOFA score, and inappropriate initial
antibiotic treatment were independent prognostic factors for 30-day mortality.