Advertisement

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

  • Hakan ErdemEmail author
  • Yasemin Cag
  • Serap Gencer
  • Serhat Uysal
  • Zuhal Karakurt
  • Rezan Harman
  • Emel Aslan
  • Esmeray Mutlu-Yilmaz
  • Oguz Karabay
  • Yesim Uygun
  • Mehmet Ulug
  • Selma Tosun
  • Arzu Dogru
  • Alper Sener
  • Mustafa Dogan
  • Rodrigo Hasbun
  • Gul Durmus
  • Hale Turan
  • Ayse Batirel
  • Fazilet Duygu
  • Asuman Inan
  • Yasemin Akkoyunlu
  • Guven Celebi
  • Gulden Ersoz
  • Tumer Guven
  • Ozgur Dagli
  • Selma Guler
  • Meliha Meric-Koc
  • Serkan Oncu
  • Jordi Rello
Original Article

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

Ventilator-associated pneumonia VAP Pneumonia Acinetobacter Mortality Treatment 

Notes

Acknowledgments

Infectious Diseases and Clinical Microbiology Specialty Society of Turkey (EKMUD) provided the web infrastructure of the study for data submission.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Dr. Lutfi Kirdar Education and Training Hospital’s Review Board in Istanbul approved the study (02/01/2014-VIP 2014/1) and this approval was confirmed the Turkish Ministry of Health, Drugs and Pharmaceutics Agency for all participating centers. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.

Informed consent

Yes, informed consent is obtained.

References

  1. 1.
    Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA et al (2014) Multistate point-prevalence survey of health care–associated infections. N Engl J Med 370:1198–1208. [cited 2018 6]. http://www.ncbi.nlm.nih.gov/pubmed/24670166.  https://doi.org/10.1056/NEJMoa1306801 CrossRefGoogle Scholar
  2. 2.
    Erdem H, Inan A, Altindis S, Carevic B, Askarian M, Cottle L et al (2014) Surveillance, control and management of infections in intensive care units in southern Europe, Turkey and Iran - a prospective multicenter point prevalence study. J Inf Secur 68:131–140.  https://doi.org/10.1016/j.jinf.2013.11.001 Google Scholar
  3. 3.
    Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63:e61–111. doi:  https://doi.org/10.1093/cid/ciw353
  4. 4.
    Vallés J, Pobo A, García-Esquirol O, Mariscal D, Real J, Fernández R (2007) Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs late onset. Intensive Care Med 33:1363–1368.  https://doi.org/10.1007/s00134-007-0721-0 CrossRefGoogle Scholar
  5. 5.
    Clark NM, Zhanel GG, Lynch JP (2016) Emergence of antimicrobial resistance among Acinetobacter species. Curr Opin Crit Care 22:491–499. [cited 2018 9]. http://www.ncbi.nlm.nih.gov/pubmed/27552304.  https://doi.org/10.1097/MCC.0000000000000337 CrossRefGoogle Scholar
  6. 6.
    Erdem H, Dizbay M, Karabey S, Kaya S, Demirdal T, Koksal I, et al. (2013) Withdrawal of Staphylococcus aureus from intensive care units in Turkey. Am J Infect Control 41. doi:  https://doi.org/10.1016/j.ajic.2013.01.041
  7. 7.
    Asif M, Alvi IA, Rehman SU (2018) Infection and drug resistance. Dovepress. Insight into Acinetobacter baumannii: pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities. 1249–60. doi:  https://doi.org/10.2147/IDR.S166750doi:10.2147/IDR.S166750
  8. 8.
    Bonell A, Azarrafiy R, Huong TVL, Viet TL, Phu VD et al (2018;doi: http://fdslive.oup.com/www.oup.com/pdf/production_in_progress.pdf) A systematic review and meta-analysis of ventilator associated pneumonia in adults in Asia: an analysis of national income level on incidence and etiology. Clin Infect Dis.  https://doi.org/10.11821/dlxb201802008
  9. 9.
    The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 4.0. 2014Google Scholar
  10. 10.
    The European committee on antimicrobial susceptibility testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 5.0 [Internet]. 2015. doi: http://www.eucast.org
  11. 11.
    The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters, version 6.0. 2016Google Scholar
  12. 12.
    Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG et al (2011) Bacteria : an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03570.x/full.  https://doi.org/10.1111/j.1469-0691.2011.03570.x CrossRefGoogle Scholar
  13. 13.
    Centers for Disease Control and Prevention (2019) (Ventilator-associated pneumonia [VAP] and non-ventilator-associated pneumonia [PNEU]) event. Device-associated module. CDC;1–16Google Scholar
  14. 14.
    White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30:377–399.  https://doi.org/10.1002/sim.4067 CrossRefGoogle Scholar
  15. 15.
    Donders ART, van der Heijden GJMG, Stijnen T, Moons KGM (2006) Review: a gentle introduction to imputation of missing values. J Clin Epidemiol 59:1087–1091.  https://doi.org/10.1016/j.jclinepi.2006.01.014 CrossRefGoogle Scholar
  16. 16.
    Cag Y, Karabay O, Sipahi OR, Aksoy F, Durmus G, Batirel A et al (2018) Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome. PLoS One 13:e0204608.  https://doi.org/10.1371/journal.pone.0204608 CrossRefGoogle Scholar
  17. 17.
    Lynch JP, Zhanel GG, Clark NM (2017) Infections due to Acinetobacter baumannii in the ICU: treatment options. Semin Respir Crit Care Med 38:311–325.  https://doi.org/10.1055/s-0037-1599225 CrossRefGoogle Scholar
  18. 18.
    Vazquez Guillamet C, Kollef MH (2018) Acinetobacter pneumonia: improving outcomes with early identification and appropriate therapy. Clin Infect Dis 67:1455–1462. https://academic.oup.com/cid/article/67/9/1455/4993159.  https://doi.org/10.1093/cid/ciy375 CrossRefGoogle Scholar
  19. 19.
    Isler B, Doi Y, Bonomo RA, Paterson DL (2018) New treatment options against carbapenem-resistant Acinetobacter baumannii infections. Antimicrob Agents Chemother ;1–43. doi: http://aac.asm.org/lookup/doi/10.1128/AAC.01110-18 doi:  https://doi.org/10.1128/AAC.01110-18
  20. 20.
    Freire AT, Melnyk V, Kim MJ, Datsenko O, Dzyublik O, Glumcher F et al (2010) Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis 68:140–151.  https://doi.org/10.1016/j.diagmicrobio.2010.05.012 CrossRefGoogle Scholar
  21. 21.
    Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, Forrest A et al (2019) International consensus guidelines for the optimal use of the polymyxins: endorsed by the ACCP, ESCMID, IDSA, ISAP, SCCM, and SIDP. Pharmacotherapy 39:10–39.  https://doi.org/10.1002/phar.2209 CrossRefGoogle Scholar
  22. 22.
    Huang AM, Newton D, Kunapuli A, Gandhi TN, Washer LL, Isip J et al (2013) Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 57:1237–1245.  https://doi.org/10.1093/cid/cit498 CrossRefGoogle Scholar
  23. 23.
    Vazquez Guillamet C, Kollef MH (2018) Is zero ventilator-associated pneumonia achievable? Clin Chest Med 39:809–822. [cited 2018 6]. http://www.ncbi.nlm.nih.gov/pubmed/30390751.  https://doi.org/10.1016/j.ccm.2018.08.004 CrossRefGoogle Scholar
  24. 24.
    Alp E, Cookson B, Erdem H, Rello J, Akhvlediani T, Akkoyunlu Y et al (2019) Infection control bundles in intensive care: an international cross-sectional survey in low-middle income countries. J Hosp Infect 101:248–256.  https://doi.org/10.1016/j.jhin.2018.07.022 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hakan Erdem
    • 1
    Email author
  • 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
  1. 1.IDI-IRIAnkaraTurkey
  2. 2.Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical MicrobiologyMedeniyet University School of MedicineIstanbulTurkey
  3. 3.Department of Infectious Diseases and Clinical MicrobiologyAcibadem Maslak HospitalIstanbulTurkey
  4. 4.Kanuni Research and Training Hospital, Department of Infectious Diseases and Clinical MicrobiologyUniversity of Health SciencesTrabzonTurkey
  5. 5.Respiratory Intensive Care UnitSureyyapasa Chest Diseases and Thoracic Surgery Education and Research HospitalIstanbulTurkey
  6. 6.Department of Infectious Diseases and Clinical MicrobiologyToros State HospitalMersinTurkey
  7. 7.Department of Infectious Diseases and Clinical MicrobiologyDicle University School of MedicineDiyarbakirTurkey
  8. 8.Department of Infectious Diseases and Clinical MicrobiologySamsun Training and Research HospitalSamsunTurkey
  9. 9.Department of Infectious Diseases and Clinical MicrobiologySakarya University School of MedicineSakaryaTurkey
  10. 10.Department of Infectious Diseases and Clinical MicrobiologyKosuyolu Training and Research HospitalIstanbulTurkey
  11. 11.Department of Infectious Diseases and Clinical MicrobiologyPrivate Umit HospitalEskisehirTurkey
  12. 12.Department of Infectious Diseases and Clinical MicrobiologyIzmir Bozyaka Training and Research HospitalIzmirTurkey
  13. 13.Department of Infectious Diseases and Clinical MicrobiologyOnsekiz Mart University School of MedicineCanakkaleTurkey
  14. 14.Department of Infectious Diseases and Clinical MicrobiologyNamik Kemal University School of MedicineTekirdagTurkey
  15. 15.Department of Infectious DiseasesUT Health McGovern Medical SchoolHoustonUSA
  16. 16.Bursa Yuksek Ihtisas Research and Training Hospital, Department of Infectious Diseases and Clinical MicrobiologyUniversity of Health SciencesBursaTurkey
  17. 17.Department of Infectious Diseases and Clinical MicrobiologyBaskent University School of MedicineKonyaTurkey
  18. 18.Dr. Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical MicrobiologyUniversity of Health SciencesIstanbulTurkey
  19. 19.Department of Infectious Diseases and Clinical MicrobiologyAnkara Oncology Training and Research HospitalAnkaraTurkey
  20. 20.Department of Infectious Diseases and Clinical MicrobiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  21. 21.School of Medicine, Department of Infectious Diseases and Clinical MicrobiologyBezmialem Vakif UniversityIstanbulTurkey
  22. 22.Faculty of Medicine, Department of Infectious Diseases and Clinical MicrobiologyBulent Ecevit UniversityZonguldakTurkey
  23. 23.Faculty of Medicine, Department of Infectious Diseases and Clinical MicrobiologyMersin UniversityMersinTurkey
  24. 24.Department of Infectious Diseases and Clinical MicrobiologyKaradeniz Eregli Medikal Park HospitalEregliTurkey
  25. 25.Department of Infectious Diseases and Clinical MicrobiologyKahramanmaras Nezip Fazil State HospitalKahramanmarasTurkey
  26. 26.School of Medicine, Department of Infectious Diseases and Clinical MicrobiologyAdnan Menderes UniversityAydinTurkey
  27. 27.Vall d’Hebron Institute of ResearchCIBERESBarcelonaSpain

Personalised recommendations