1.The Outcomes of Using Colistin for Treating Multidrug Resistant Acinetobacter Species Bloodstream Infections.
Seung Kwan LIM ; Sang Oh LEE ; Seong Ho CHOI ; Jae Phil CHOI ; Sung Han KIM ; Jin Yong JEONG ; Sang Ho CHOI ; Jun Hee WOO ; Yang Soo KIM
Journal of Korean Medical Science 2011;26(3):325-331
Despite the identification of Acinetobacter baumannii isolates that demonstrate susceptibility to only colistin, this antimicrobial agent was not available in Korea until 2006. The present study examined the outcomes of patients with multidrug resistant (MDR) Acinetobacter species bloodstream infection and who were treated with or without colistin as part of their regimen. The colistin group was given colistin as part of therapy once colistin became available in 2006. The non-colistin group was derived from the patients who were treated with other antimicrobial regimens before 2006. Mortality within 30 days of the onset of bacteremia occurred for 11 of 31 patients in the colistin group and for 15 of 39 patients in the non-colistin group (35.5% vs 38.5%, respectively, P = 0.80). Renal dysfunction developed in 50.0% of the 20 evaluable patients in the colistin group, but in 28.6% of the 35 evaluable patients in the non-colistin group (P = 0.11). On multivariate analysis, only an Acute Physiological and Chronic Health Evaluation II score > or = 21 was associated with mortality at 30 days. This result suggests that administering colistin, although it is the sole microbiologically appropriate agent, does not influence the 30 day mortality of patients with a MDR Acinetobacter spp. bloodstream infection.
APACHE
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Acinetobacter/*drug effects/isolation & purification
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Acinetobacter Infections/*drug therapy/mortality
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Adolescent
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Adult
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Aged
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Aged, 80 and over
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Anti-Bacterial Agents/*therapeutic use
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Bacteremia/*drug therapy/mortality
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Child
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Colistin/administration & dosage/*therapeutic use
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Drug Resistance, Multiple, Bacterial/*drug effects
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Female
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Humans
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Male
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Middle Aged
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Republic of Korea
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Retrospective Studies
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Risk
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Treatment Outcome
2.Risk Factors for Occurrence and 30-Day Mortality for Carbapenem-Resistant Acinetobacter baumannii Bacteremia in an Intensive Care Unit.
Song Yee KIM ; Ji Ye JUNG ; Young Ae KANG ; Joo Eun LIM ; Eun Young KIM ; Sang Kook LEE ; Seon Cheol PARK ; Kyung Soo CHUNG ; Byung Hoon PARK ; Young Sam KIM ; Se Kyu KIM ; Joon CHANG ; Moo Suk PARK
Journal of Korean Medical Science 2012;27(8):939-947
To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.
Acinetobacter Infections/drug therapy/epidemiology/*mortality
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Acinetobacter baumannii/*drug effects
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Adult
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Aged
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Anti-Bacterial Agents/*pharmacology/therapeutic use
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Bacteremia/drug therapy/epidemiology/*mortality
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Carbapenems/*pharmacology/therapeutic use
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Case-Control Studies
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Drug Resistance, Multiple, Bacterial
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Female
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Humans
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Immunocompromised Host
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Intensive Care Units
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Male
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Middle Aged
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Odds Ratio
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Renal Insufficiency/etiology
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Retrospective Studies
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Risk Factors
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Survival Rate
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Time Factors
3.The Causes and Treatment Outcomes of 91 Patients with Adult Nosocomial Meningitis.
Hye In KIM ; Shin Woo KIM ; Ga Young PARK ; Eu Gene KWON ; Hyo Hoon KIM ; Ju Young JEONG ; Hyun Ha CHANG ; Jong Myung LEE ; Neung Su KIM
The Korean Journal of Internal Medicine 2012;27(2):171-179
BACKGROUND/AIMS: Frequent pathogens of nosocomial meningitis were investigated and the adequacy of empiric antibiotic therapy was assessed. Outcomes of nosocomial meningitis were also evaluated. METHODS: Ninety-one patients, who were diagnosed and treated for nosocomial meningitis at a single tertiary hospital in Daegu, Korea for 10 years, were included. Medical record and electronic laboratory data on the causative pathogens, antibiotics used, and outcomes were retrospectively investigated. RESULTS: Coagulase-negative Staphylococcus (40.9%) was the most common pathogen, followed by Acinetobacter (32.5%). Both were cultured as a single organism in cerebrospinal fluid (CSF). Seventy-eight patients (85.7%) had infections related to external ventricular drains (EVD). The most common empirical antibiotics were extended-spectrum beta-lactam antibiotics plus vancomycin (35/91, 38.6%). Of the 27 patients who had cultured Acinetobacter in CSF, 10 (37%) were given the wrong empirical antibiotic treatment. Seven of the 27 patients (26.9%) with cultured Acinetobacter died, and overall mortality of the 91 patients was 16.5%. In the multivariate analysis, the presence of combined septic shock (p < 0.001) and a persistent EVD state (p = 0.021) were associated with a poor prognosis. CONCLUSIONS: Acinetobacter is one of the leading pathogens of nosocomial meningitis and may lead to inadequate coverage of empiric antibiotic therapy due to increasing resistance. An EVD should be removed early in cases of suspected nosocomial meningitis, and carbapenem might be required for the poor treatment response.
Acinetobacter/classification/*isolation & purification
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Acinetobacter Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology
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Adult
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Aged
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Aged, 80 and over
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Anti-Bacterial Agents/*therapeutic use
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Cerebrospinal Fluid/microbiology
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Cross Infection/cerebrospinal fluid/diagnosis/*microbiology/mortality/*therapy
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Drug Resistance, Bacterial
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Female
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Humans
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Logistic Models
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Male
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Meningitis, Bacterial/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality
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Middle Aged
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Multivariate Analysis
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Odds Ratio
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Republic of Korea
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Retrospective Studies
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Risk Assessment
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Risk Factors
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Staphylococcal Infections/cerebrospinal fluid/diagnosis/*drug therapy/*microbiology/mortality
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Staphylococcus/classification/*isolation & purification
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Time Factors
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Treatment Outcome
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Young Adult
4.Comparison of Efficacy of Cefoperazone/Sulbactam and Imipenem/Cilastatin for Treatment of Acinetobacter Bacteremia.
Jun Yong CHOI ; Chang Oh KIM ; Yoon Seon PARK ; Hee Jung YOON ; So Youn SHIN ; Young Keun KIM ; Myung Soo KIM ; Yeon A KIM ; Young Goo SONG ; Dongeun YONG ; Kyungwon LEE ; June Myung KIM
Yonsei Medical Journal 2006;47(1):63-69
Multiple antibiotic reisistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/ cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/ sulbactam group and imipenem/ cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.
Sulbactam/*therapeutic use
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Protease Inhibitors/therapeutic use
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Middle Aged
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Male
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Imipenem/therapeutic use
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Humans
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Female
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Drug Therapy, Combination
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Drug Resistance, Bacterial
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Cilastatin/therapeutic use
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Cefoperazone/*therapeutic use
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Bacteremia/*drug therapy
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Anti-Bacterial Agents/*therapeutic use
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Aged
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Adult
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Adolescent
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Acinetobacter Infections/*drug therapy/mortality
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Acinetobacter/drug effects/isolation & purification
5.Clinical manifestations of pneumonia according to the causative organism in patients in the intensive care unit.
Jung Kyu LEE ; Jinwoo LEE ; Young Sik PARK ; Chang Hoon LEE ; Jae Joon YIM ; Chul Gyu YOO ; Young Whan KIM ; Sung Koo HAN ; Sang Min LEE
The Korean Journal of Internal Medicine 2015;30(6):829-836
BACKGROUND/AIMS: Whether the causative organism influences the clinical course of pneumonia in the intensive care unit (ICU) is controversial. We assessed the clinical manifestations and prognosis of pneumonia according to the causative pathogens in patients in a medical ICU. METHODS: A retrospective observational study was performed in a medical ICU. Among 242 patients who were admitted to the ICU, 103 who were treated for pneumonia were analyzed. RESULTS: The causative pathogen was identified in 50 patients (49.0%); 22 patients (21.6%) had multidrug-resistant (MDR) pathogens. The distribution of causative micro-organisms was Staphylococcus aureus (20%), Pseudomonas species (16%), Klebsiella pneumoniae (14%), and Acinetobacter baumannii (12%). No significant difference in ICU mortality rate, duration of ICU stay, duration of mechanical ventilation, or frequencies of re-intubation and tracheostomy were detected based on the identification of any pathogen. In sub-analyses according to the pneumonia classification, the number of pathogens identified did not differ between pneumonia types, and a higher incidence of identified MDR pathogens was detected in the hospital-acquired pneumonia group than in the community-acquired or healthcare- acquired pneumonia groups. However, the clinical outcomes of pneumonia according to identification status and type of pathogen did not differ significantly between the groups. CONCLUSIONS: Neither the causative micro-organism nor the existence of MDR pathogens in critically ill patients with pneumonia was associated with the clinical outcome of pneumonia, including ICU mortality. This result was consistent regardless of the pneumonia classification.
Acinetobacter Infections/diagnosis/*microbiology/mortality/therapy
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Aged
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Anti-Bacterial Agents/therapeutic use
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Critical Illness
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Drug Resistance, Multiple, Bacterial
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Female
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Hospital Mortality
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Humans
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Intensive Care Units
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Klebsiella Infections/diagnosis/*microbiology/mortality/therapy
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Length of Stay
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Male
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Middle Aged
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Pneumonia, Bacterial/diagnosis/*microbiology/mortality/therapy
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Proportional Hazards Models
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Pseudomonas Infections/diagnosis/*microbiology/mortality/therapy
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Respiration, Artificial
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Retrospective Studies
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Risk Factors
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Staphylococcal Infections/diagnosis/*microbiology/mortality/therapy
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Time Factors
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Tracheostomy
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Treatment Outcome
6.Healthcare-associated Pneumonia: Clinical Features and Retrospective Analysis Over 10 Years.
Fei QI ; Guo-Xin ZHANG ; Dan-Yang SHE ; Zhi-Xin LIANG ; Ren-Tao WANG ; Zhen YANG ; Liang-An CHEN ; Jun-Chang CUI
Chinese Medical Journal 2015;128(20):2707-2713
BACKGROUNDHealthcare-associated pneumonia (HCAP) is associated with drug-resistant pathogens and high mortality, and there is no clear evidence that this is due to inappropriate antibiotic therapy. This study was to elucidate the clinical features, pathogens, therapy, and outcomes of HCAP, and to clarify the risk factors for drug-resistant pathogens and prognosis.
METHODSRetrospective observational study among hospitalized patients with HCAP over 10 years. The primary outcome was 30-day all-cause hospital mortality after admission. Demographics (age, gender, clinical features, and comorbidities), dates of admission, discharge and/or death, hospitalization costs, microbiological results, chest imaging studies, and CURB-65 were analyzed. Antibiotics, admission to Intensive Care Unit (ICU), mechanical ventilation, and pneumonia prognosis were recorded. Patients were dichotomized based on CURB-65 (low- vs. high-risk).
RESULTSAmong 612 patients (mean age of 70.7 years), 88.4% had at least one comorbidity. Commonly detected pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Initial monotherapy with β-lactam antibiotics was the most common initial therapy (50%). Mean age, length of stay, hospitalization expenses, ICU admission, mechanical ventilation use, malignancies, and detection rate for P. aeruginosa, and Staphylococcus aureus were higher in the high-risk group compared with the low-risk group. CURB-65 ≥3, malignancies, and mechanical ventilation were associated with an increased mortality. Logistic regression analysis showed that cerebrovascular diseases and being bedridden were independent risk factors for HCAP.
CONCLUSIONInitial treatment of HCAP with broad-spectrum antibiotics could be an appropriate approach. CURB-65 ≥3, malignancies, and mechanical ventilation may result in an increased mortality.
Acinetobacter baumannii ; pathogenicity ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Community-Acquired Infections ; drug therapy ; microbiology ; pathology ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Male ; Middle Aged ; Pneumonia ; drug therapy ; microbiology ; pathology ; Pseudomonas aeruginosa ; pathogenicity ; Retrospective Studies ; Staphylococcus aureus ; pathogenicity
7.Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia: Impact of Appropriate Antimicrobial Therapy.
Youn Jeong KIM ; Sang Il KIM ; Kyung Wook HONG ; Yang Ree KIM ; Yeon Joon PARK ; Moon Won KANG
Journal of Korean Medical Science 2012;27(5):471-475
This study investigated predictors associated with 14-day mortality, and focused especially on the impact of appropriate antimicrobial treatment among patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia. This retrospective study was performed at a tertiary care hospital in Korea from June 2007 to June 2010. Antibiotic therapy was considered appropriate if the antibiotics were administered via an appropriate route within 24 hr after the result of blood culture, had in vitro sensitivity to isolated strains, and of an adequate dosage according to the current guidelines. Ninety-five patients with A. baumannii bacteremia were included; of these, 53 (55.8%) were infected with CRAB. The overall infection-related 14-day mortality was higher in patients receiving inappropriate antimicrobial therapy than in patients receiving appropriate therapy (59.5% [22/37] vs 13.8% [8/58], P < 0.05). Multivariate analysis showed that septic shock (OR 10.5, 95% CI, 1.93-57.4; P = 0.006), carbapenem-resistance (OR 7.29, 95% CI 1.57-33.8; P = 0.01), pneumonia as a source of bacteremia (OR 5.29, 95% CI 1.07-26.1; P = 0.04), and inappropriate antimicrobial therapy (OR 8.05, 95% CI 1.65-39.2; P = 0.009) were independent risk factors for 14-day mortality. Early definite antimicrobial therapy had an influence on favorable outcomes in patients with A. baumannii bacteremia.
APACHE
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Acinetobacter Infections/drug therapy/microbiology/*mortality
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Acinetobacter baumannii/drug effects/*isolation & purification
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Adult
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Age Factors
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Aged
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Anti-Bacterial Agents/*therapeutic use
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Carbapenems/pharmacology
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Diabetes Complications
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Drug Resistance, Bacterial
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Female
;
Humans
;
Male
;
Middle Aged
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Odds Ratio
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Pneumonia/etiology
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Prognosis
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Retrospective Studies
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Risk Factors
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Shock, Septic/etiology
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Survival Rate