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

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Citation: Critical Care (London, England). 20(1):221, 2016 Jul 11PMID: 27417949Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Acinetobacter Infections/dt [Drug Therapy] | *Drug Resistance, Multiple | *Hospital Mortality | *Sepsis/dt [Drug Therapy] | Acinetobacter baumannii/py [Pathogenicity] | Aged | Anti-Bacterial Agents/pd [Pharmacology] | Anti-Bacterial Agents/tu [Therapeutic Use] | Cohort Studies | Female | Humans | Intensive Care Units/og [Organization & Administration] | Male | Middle Aged | Retrospective Studies | Risk Factors | Statistics, NonparametricYear: 2016Local holdings: Available online from MWHC library: 1997 - present (after 1 year)ISSN:
  • 1364-8535
Name of journal: Critical care (London, England)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.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.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).All authors: Fan W, Nathanson BH, Shorr AF, Sulham K, Zilberberg MDFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 27417949 Available 27417949

Available online from MWHC library: 1997 - present (after 1 year)

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.

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.

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).

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