1427. Clinical Outcome of Bacteremic Pneumnia Caused by Carbapenem-Resistant Acinetobacter baumannii in a University Hospital: impact of appropriate antimicrobial therapy
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background:

Acinetobacter baumannii has emerged as a major cause of nosocomial infections.

The aim of this study is to identify 14-day mortality of patients with bacteremic pneumonia caused by carbapenem-resistant Acinetobacter baumannii(CRAB) and to assess the impact of appropriate antimicrobial therapy.

Methods:

We reviewed all blood culture reports in a Korean university hospital with approximately 750 beds from November 2006 to March 2012. Patients with 18 years of age or older with documented cases of CRAB pneumonia sepsis were enrolled. Demographic, clinical and microbiological data were collected. Appropriate antimicrobial therapy was defined if colistin was administered via an appropriate route within 24hr after the result of blood culture.

Results:

Thirty four cases (29.0%) were enrolled from 117 cases of CRAB bacteremia. Mortality within 14 days of the onset of bacteremia occurred for 27 of 34 patients (79.4%). The mean duration from obtaining blood culture to mortality was 3.85 ± 3.39 days and 3-day was the median. The overall infection related 14-day mortality was higher in patients with inappropriate antimicrobial therapy than in patients receiving appropriate therapy (92.3% [24/26] vs 37.5% [3/8]).Univariate analysis showed that Charlson’s Index, Pitt bacteremia score (table 1) and inappropriate antimicrobial therapy(p=0.004) were associated with mortality. Multivariate analysis revealed that inappropriate antimicrobial therapy was the only significant factor that could predict overall 14-days mortlity (OR 19.42; 95% CI 1.19-315.90,  p=.037).

 

Table 1    Characteristics of the study population.

Characteristic

Survivors (n=7)

Non-survivors (n=27)

       P

Age, years

 

 

 

 Mean±SD

51.4±14.95

61.00±16.19

.174

Male, n (%)

4 (57.5)

18 (66.7)

.677

Charlson’s Index

 

 

 

 Mean±SD

1.28±1.11

3.03±1.84

.023

Pitt bacteremia score

 

 

 

 Mean±SD

5.00±1.29

6.55±2.85

.046

 

 

 

 

Conclusion:

Bacteremic pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB) shows significant mortality and early appropriate antimicrobial therapy has an influence on favorable clinical outcome.

Jin Seo Lee, M.D., Department of Internal Medicine, division of infectious disease, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea, Seugjin Lim, Division of Infectious Diseases, Samsung Medical Center , Seoul , South Korea and Joong Sik Eom, M.D., Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea, Republic of

Disclosures:

J. S. Lee, None

S. Lim, None

J. S. Eom, None

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