Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis

• Published in: Critical care (London, England) England), 2016-07, Vol.20 (1), p.221-221, Article 221
• Main Authors: Zilberberg, Marya D, Nathanson, Brian H, Sulham, Kate, Fan, Weihong, Shorr, Andrew F
• Format: Article
• Language: English
• Subjects: Acinetobacter baumannii; Analysis; Bacterial pneumonia; Care and treatment; Causes of; Drug resistance in microorganisms; Physiological aspects; Pneumonia
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/s13054-016-1392-4

The relationship between multidrug resistance (MDR), inappropriate empiric therapy (IET), and mortality among patients with Acinetobacter baumannii (AB) remains unclear. We examined it using a large U.S. We conducted a retrospective cohort study using the Premier Research database (2009-2013) of 175 U.S. hospitals. We included all adult patients admitted with pneumonia or sepsis as their principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, along with antibiotic administration within 2 days of admission. Only culture-confirmed infections were included. Resistance to at least three classes of antibiotics defined multidrug-resistant AB (MDR-AB). We used logistic regression to compute the adjusted relative risk ratio (RRR) of patients with MDR-AB receiving IET and IET's impact on mortality. Among 1423 patients with AB infection, 1171 (82.3 %) had MDR-AB. Those with MDR-AB were older (63.7 ± 15.4 vs. 61.0 ± 16.9 years, p = 0.014). Although chronic disease burden did not differ between groups, the MDR-AB group had higher illness severity than those in the non-MDR-AB group (intensive care unit 68.0 % vs. 59.5 %, p