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RESEARCH PAPER
Analysis of applied empirical treatments against VAP caused by Acinetobacter baumannii
 
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1
Laboratorium Mikrobiologii, Mazowiecki Szpital Specjalistyczny w Radomiu
 
2
Państwowa Szkoła Wyższa im. Papieża Jana Pawła II w Białej Podlaskiej
 
 
Corresponding author
Aneta Grochowalska   

Laboratorium Mikrobiologii, Mazowiecki Szpital Specjalistyczny w Radomiu, Aleksandrowicza 5, 26-617 Radom, Polska
 
 
Med Og Nauk Zdr. 2017;23(3):189-195
 
KEYWORDS
TOPICS
ABSTRACT
Objectives:
The aim of the study was analysis of A. baumannii strains, isolated from hospital samples from the lower respiratory tract collected from patients with VAP hospitalized in Masovian Specialist Hospital’s ICU in Radom between 2012 and 2014. The frequency of occurrence and drug susceptibility of these bacteria was evaluated, as well as the applied empirical treatment and its effectiveness in ICU with the recommendations in effect.

Material and methods:
Retrospective study was conducted during the period from 1 January – 31 December 2014, in ICU among patients with the diagnosis of VAP, aggravating factors were analyzed and A.baumannii isolated.

Results:
Studies included 755 patients with the suspicion of VAP. A. baumannii was isolated in 141 patients with confirmed VAP. Moreover, in the examined group, in 34 patients in addition to A. baumannii another strain was isolated, considered as etiological factor participating in coinfection. A considerable part of A. baumannii strains were characterized by high resistance (> 90%) to selected antibiotics. Analysis of the empirical treatment applied showed that the level of accuracy of therapy for A. baumannii in early VAP was 31%, and for the remaining strains – 57%, while in late VAP the sensitivity of A. baumannii was 11% and for the species causing coinfection – 24%. In patients with an early diagnosis of VAP, after targeted antibiotic therapy an improvement of clinical condition was observed in 35% of patients, whereas in those with late diagnosis – in 61% of patients.

Conclusions:
In the conducted study, infections caused by multi-resistant A. baumannii were observed more frequently in late VAP, which should be taken into consideration while choosing empirical antibiotic therapy. Simultaneously, the local resistance patterns of multi-drug-resistant Gram-negative strains co-infecting VAP should be considered in empirical treatment. Moreover, both additional clinical complication and co-infections contribute to more severe course of diseases.

 
REFERENCES (16)
1.
Bor C, Demirag K, Okcu O, Cankayali I, Uyar M. Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage. Pak J Med Sci. 2015; 31(6): 1441–6.
 
2.
Kiaei BA, Ghiasi F, Moradi D. Precalcitonin and C-reactive protein as markers in response to antibiotic treatment in ventilator-associated pneumonia in intensive care unit-hospitalized patients. Adv Biomed Res. 2015; 4: 240.
 
3.
Wałaszek M, Wolak Z, Dobroś W. Nosocomial infection in patients hospitalized in 2005–2011. The St. Lukas district hospital in Tarnów. Przegl Epidemiol 2012; 66: 617–621.
 
4.
Duszyńska W, Rosenthal VD, Dragan B, et al. Ventilator-associated pneumonia monitoring according to the INICC project at one centre. Anaesthesiol Intensive Ther 2015; 47: 34–39.
 
5.
Almomani BA, McCullough A, Gharaibeh R, Samrah S, Mahasneh F. Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia. J Infect Dev Ctries. 2015; 9(12): 1323–30.
 
6.
Waltrick R, Possamai DS, Aguiar FP, Dadam M, Souza Filho VJ, Ramos LR, Laurett RD, Fujiwara K, Caldeira Filho M, Koenig Á, Westphal GA. Comparison between a clinical diagnosis method and the surve¬illance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia. Rev Bras Ter Intensiva. 2015; 27(3): 260–265.
 
7.
Woods DE, Bass JA, Johanson WG Jr, Straus DC. Role of adherence in the pathogenesis of Pseudomonas aeruginosa lung infection in cystic fibrosis patients. Infect Immun. 1980; 30(3): 694–9.
 
8.
Woods DE, Straus DC, Johanson WG Jr, Bass JA. Role of salivary protease activity in adherence of gram-negative bacilli to mammalian buccal epithelial cells in vivo. J Clin Invest. 1981; 68(6): 1435–40.
 
9.
Nseir S, Lorente L, Ferrer M, Rouzé A, Gonzalez O, Bassi GL, Duhamel A, Torres A. Continuous control of tracheal cuff pressure for VAP pre¬vention: a collaborative meta-analysis of individual participant data. Ann Intensive Care. 2015; 5(1): 43.
 
10.
Hryniewicz W, Ozorowski T, i wsp. Rekomendacje diagnostyki, tera¬pii i profilaktyki antybiotykowej zakażeń w szpitalu. Narodowy Pro-gram Ochrony Antybiotyków. 2015. www.antybiotyki.edu.pl (dostęp: 27.04.2017).
 
11.
American Thoracic Society, Infectious Diseases Society of Ameri¬ca: Guidelines for the management of adults with hospital-acquired, ventilator associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171: 388–416. https://www.thoracic.org/ statements/resources/mtpi/guide1–29.pdf (dostęp: 27.04.2017).
 
12.
Janahiraman S, Aziz MN, Hoo FK, P›ng HS, Boo YL, Ramachandran V, Shamsuddin AF. Resistance patterns of multidrug resistant Acine-tobacter baumannii in an ICU of a tertiary care hospital, Malaysia. Pak J Med Sci. 2015; 31(6): 1383–8.
 
13.
Philippart F, Bouroche G, Timsit JF, Garrouste-Orgeas M, Azoulay E, Darmon M, Adrie C, Allaouchiche B, Ara-Somohano C, Ruckly S1, Dumenil AS, Souweine B, Goldgran-Toledano D, Bouadma L, Misset B. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection. PLoS One. 2015; 10(9).
 
14.
Ali M Marie M, Gowda Krishnappa L, J Alzahrani A, A Mubaraki M, A Alyousef A. A prospective evaluation of synergistic effect of sulbac¬tam and tazobactam combination with meropenem or colistin against multidrug resistant Acinetobacter baumannii. Bosn J Basic Med Sci. 2015; 15(4): 24–9.
 
15.
Yilmaz GR, Guven T, Guner R, Kocak Tufan Z, Izdes S, Tasyaran MA, Acikgoz ZC. Colistin alone or combined with sulbactam or carbapenem against A. baumannii in ventilator-associated pneumonia. J Infect Dev Ctries 2015; 9(5): 476–485.
 
16.
Qureshi ZA, Hittle LE, O’Hara JA, Rivera JI, Syed A, Shields RK, Pas¬culle AW, Ernst RK, Doi Y. Colistin-resistant Acinetobacter baumannii: beyond carbapenem resistance. Clin Infect Dis. 2015; 60(9): 1295–303.
 
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