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. 2016 Jul 11;20(1):221.
doi: 10.1186/s13054-016-1392-4.

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

Marya D Zilberberg  1 , Brian H Nathanson  2 , Kate Sulham  3 , Weihong Fan  3 , Andrew F Shorr  4
Affiliations

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

Marya D Zilberberg et al. Crit Care. .

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.

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).

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.

Keywords: Acinetobacter baumannii; Inappropriate empiric therapy; Multidrug resistance; Outcomes; Pneumonia; Sepsis.

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Figures

Fig. 1
Fig. 1
Inappropriate empiric therapy as a function of multidrug resistance (MDR). HCA healthcare-associated
Fig. 2
Fig. 2
Mortality and inappropriate empiric therapy. HCA healthcare-associated
See this image and copyright information in PMC

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