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Observational Study
. 2020 Jan;39(1):45-52.
doi: 10.1007/s10096-019-03691-z. Epub 2019 Sep 9.

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

Hakan Erdem  1 , Yasemin Cag  2 , Serap Gencer  3 , Serhat Uysal  4 , Zuhal Karakurt  5 , Rezan Harman  6 , Emel Aslan  7 , Esmeray Mutlu-Yilmaz  8 , Oguz Karabay  9 , Yesim Uygun  10 , Mehmet Ulug  11 , Selma Tosun  12 , Arzu Dogru  2 , Alper Sener  13 , Mustafa Dogan  14 , Rodrigo Hasbun  15 , Gul Durmus  16 , Hale Turan  17 , Ayse Batirel  18 , Fazilet Duygu  19 , Asuman Inan  20 , Yasemin Akkoyunlu  21 , Guven Celebi  22 , Gulden Ersoz  23 , Tumer Guven  24 , Ozgur Dagli  16 , Selma Guler  25 , Meliha Meric-Koc  21 , Serkan Oncu  26 , Jordi Rello  27
Affiliations
Observational Study

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

Hakan Erdem et al. Eur J Clin Microbiol Infect Dis. 2020 Jan.

Abstract

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279-2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454-0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142-23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046-5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216-0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037-0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes.

Keywords: Acinetobacter; Mortality; Pneumonia; Treatment; VAP; Ventilator-associated pneumonia.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Colistin use at the start of therapy
Fig. 2
Fig. 2
Therapeutic courses in VAP due to Acinetobacter spp.
See this image and copyright information in PMC

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