Clinical Outcomes and Risk Factors Affecting on Clinical Outcomes in Patients with
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Published:
Jan 13, 2014
Keywords:
Acinetobacter baumannii carbapenem-resistant clinical outcomes risk factors
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Abstract
This study aimed to determine percentage of 30-days mortality and treatment failure in patients infected with carbapenem-resistant Acinetobacterbaumanii (CRAB) and to evaluate predictive factors associated with 30-days mortality and treatment failure. This retrospective study collected data from medical records of patients hospitalized at Huahin Hospital from January to December 2012. Seventy three patients with CRAB infections met eligible criteria, 57.5 and 61.6% were death and treatment failure rate, respectively. Risk factors associated with 30-days mortality were appropriate antimicrobial therapy (OR 0.22; 95% CI 0.08-0.62) and shock (OR 5.80; 95% CI 1.19-28.20), whereas the appropriate antimicrobial therapy (OR 0.11;95%CI 0.03-0.37) and shock (OR 10.97;95%CI 1.35-89.34) were also predictors for treatment failure. In multivariate analysis, a factor associated with 30-days mortality and treatment failure remained the appropriate antimicrobial therapy. In conclusion, the appropriate antimicrobial treatment was a strategy associated with better treatment outcomes in patients with CRAB infections.
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How to Cite
Sumret, W., Limsubjaroen, K., Ruangnara, N., Sujarittham, P., Mulmek, P., Saelim, W., & Santimaleeworagun, W. (2014). Clinical Outcomes and Risk Factors Affecting on Clinical Outcomes in Patients with. Science, Engineering and Health Studies, 8(1), 9–17. https://doi.org/10.14456/sustj.2014.5
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Research Articles
References
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Bonomo, R. A. and Szabo, D. (2006). Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clinical Infectious Diseases 43 Suppl, 2: S49-56.
Calandra, T. and Cohen, J. (2005). The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Critical Care Medicine, 33(7): 1538-1548.
Dejsirilert, S., Tiengrim, S., Sawanpanyalert, P., Aswapokee, N., and Malathum, K. (2009). Antimicrobial resistance of Acinetobacter baumannii: six years of National Antimicrobial Resistance Surveillance Thailand (NARST) surveillance. Journal of the Medical Association of Thailand, 92 Suppl 4: S34-45.
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Erbay, A., Idil, A., Gozel, M. G., Mumcuoglu, I., and Balaban, N. (2009). Impact of early appropriate antimicrobial therapy on survival in Acinetobacter baumannii bloodstream infections. International Journal of Antimicrobial Agents, 34(6): 575-579.
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Hsueh, P. R., Chen, W. H., and Luh, K. T. (2005). Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991-2003 at a university hospital in Taiwan. International Journal of Antimicrobial Agents, 26(6): 463-472.
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Lee, Y. T., Tsao, S. M., and Hsueh, P. R. (2013) Clinical outcomes of tigecycline alone or in combination with other antimicrobial agents for the treatment of patients with healthcare-associated multidrug-resistant Acinetobacter baumannii infections. European Journal of Clinical Microbiology & Infectious Diseases, 32(9):1211-1220.
Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E., Angus, D., Cook, D., Cohen, J., Opal, S. M., Vincent, J. L., and Ramsay, G. (2003). 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Medicine, 31(4): 1250-1256.
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Marshall, C., Richards, M., Black, J., Sinickas, V., Dendle, C., Korman, T., and Spelman, D. (2007). A longitudinal study of Acinetobacter in three Australian hospitals. Journal of Hospital Infection, 67(3): 245-252.
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Prates, C. G., Martins, A. F., Superti, S. V., Lopes, F. S., Ramos, F., Cantarelli, V. V., and Zavascki, A. P. (2010). Risk factors for 30-day mortality in patients with carbapenem-resistant Acinetobacter baumannii during an outbreak in an intensive care unit. Epidemiology and Infection, 139(3): 411-418.
Santimaleeworagun, W., Wongpoowarak, P., Chayakul, P., Pattharachayakul, S., Tansakul, P., and Garey, K. W. (2011a). Clinical outcomes of patients infected with carbapenem-resistant Acinetobacter baumannii treated with single or combination antibiotic therapy. Journal of the Medical Association of Thailand, 94(7): 863-870.
Santimaleeworagun, W., Wongpoowarak, P., Chayakul, P., Pattharachayakul, S., Tansakul, P., and Garey, K. W. (2011b) In vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against clinical isolates of carbapenem-resistant Acinetobacter baumannii producing OXA-23 carbapenemases. Southeast Asian Journal of Tropical Medicine and Public Health, 42(4): 890-900.
Sheng, W. H., Liao, C. H., Lauderdale, T. L., Ko, W. C., Chen, Y. S., Liu, J. W., Lau, Y. J., Wang, L. H., Liu, K. S., Tsai, T. Y., Lin, S. Y., Hsu, M. S., Hsu, L. Y., and Chang, S. C. (2010). A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii. International Journal of Infectious Diseases 14(9): e764-e769.
Thapa, B., Tribuddharat, C., Srifuengfung, S., and Dhiraputra, C. (2010). High prevalence of bla(OXA)-23 in oligoclonal carbapenem-resistant Acinetobacter baumannii from Siriraj Hospital, Mahidol University, Bangkok, Thailand. Southeast Asian Journal of Tropical Medicine and Public Health, 41(3): 625-635.
Wisplinghoff, H., Bischoff, T., Tallent, S. M., Seifert, H., Wenzel, R. P., and Edmond, M. B. (2004). Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical Infectious Diseases, 39(3): 309-317.
Apisarnthanarak, A. and Mundy, L. M. (2009). Mortality associated with Pandrug-resistant Acinetobacter baumannii infections in Thailand. American Journal of Infection Control, 37(6): 519-520.
Bergogne-Berezin, E. and Towner, K. J. (1996). Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clinical Microbiology Reviews, 9(2): 148-165.
Bonomo, R. A. and Szabo, D. (2006). Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa. Clinical Infectious Diseases 43 Suppl, 2: S49-56.
Calandra, T. and Cohen, J. (2005). The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Critical Care Medicine, 33(7): 1538-1548.
Dejsirilert, S., Tiengrim, S., Sawanpanyalert, P., Aswapokee, N., and Malathum, K. (2009). Antimicrobial resistance of Acinetobacter baumannii: six years of National Antimicrobial Resistance Surveillance Thailand (NARST) surveillance. Journal of the Medical Association of Thailand, 92 Suppl 4: S34-45.
Deris, Z. Z., Harun, A., Shafei, M. N., Rahman, R. A., and Johari, M. R. (2009). Outcomes and appropriateness of management of nosocomial Acinetobacter bloodstream infections at a teaching hospital in northeastern Malaysia. Southeast Asian Journal of Tropical Medicine and Public Health, 40(1): 140-147.
Erbay, A., Idil, A., Gozel, M. G., Mumcuoglu, I., and Balaban, N. (2009). Impact of early appropriate antimicrobial therapy on survival in Acinetobacter baumannii bloodstream infections. International Journal of Antimicrobial Agents, 34(6): 575-579.
Falagas, M. E., Kasiakou, S. K., Rafailidis, P. I., Zouglakis, G., and Morfou, P. (2006). Comparison of mortality of patients with Acinetobacter baumannii bacteraemia receiving appropriate and inappropriate empirical therapy. Journal of Antimicrobial Chemotherapy, 57(6): 1251-1254.
Hello, S. L., Falcot, V., Lacassin, F., Mikulski, M., and Baumann, F. (2010) Risk factors for carbapenem-resistant Acinetobacter baumannii infections at a tertiary care hospital in New Caledonia, South Pacific. Scandinavian Journal of Infectious Diseases, 42(11-12): 821-826.
Hsueh, P. R., Chen, W. H., and Luh, K. T. (2005). Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991-2003 at a university hospital in Taiwan. International Journal of Antimicrobial Agents, 26(6): 463-472.
Jamulitrat, S., Thongpiyapoom, S., and Suwalak, N. (2007). An outbreak of imipenem-resistant Acinetobacter baumannii at Songklanagarind Hospital: the risk factors and patient prognosis. Journal of the Medical Association of Thailand, 90(10): 2181-2191.
Lee, Y. T., Tsao, S. M., and Hsueh, P. R. (2013) Clinical outcomes of tigecycline alone or in combination with other antimicrobial agents for the treatment of patients with healthcare-associated multidrug-resistant Acinetobacter baumannii infections. European Journal of Clinical Microbiology & Infectious Diseases, 32(9):1211-1220.
Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E., Angus, D., Cook, D., Cohen, J., Opal, S. M., Vincent, J. L., and Ramsay, G. (2003). 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Medicine, 31(4): 1250-1256.
Livermore, D. M., Hill, R. L., Thomson, H., Charlett, A., Turton, J. F., Pike, R., Patel, B. C., Manuel, R., Gillespie, S., Balakrishnan, I., Barrett, S. P., Cumberland, N., and Twagira, M. (2010). Antimicrobial treatment and clinical outcome for infections with carbapenem- and multiply-resistant Acinetobacter baumannii around London. International Journal of Antimicrobial Agents, 35(1): 19-24.
Marshall, C., Richards, M., Black, J., Sinickas, V., Dendle, C., Korman, T., and Spelman, D. (2007). A longitudinal study of Acinetobacter in three Australian hospitals. Journal of Hospital Infection, 67(3): 245-252.
National Antimicrobial Resistance Surveillance Center (2007). Result of antimicrobial resistantce surveillance. [Online URL:https://narst.dmsc.moph.go.th/] accessed on April 1, 2013.
National Antimicrobial Resistance Surveillance Center (2010). Result of antimicrobial resistantce surveillance. [Online URL:https://narst.dmsc.moph.go.th/] accessed on April 1, 2013.
Niumsup, P. R., Boonkerd, N., Tansawai, U., and Tiloklurs, M. (2009). Carbapenem-resistant Acinetobacter baumannii producing OXA-23 in Thailand. Japanese Journal of Infectious Diseases, 62(2): 152-154.
Prates, C. G., Martins, A. F., Superti, S. V., Lopes, F. S., Ramos, F., Cantarelli, V. V., and Zavascki, A. P. (2010). Risk factors for 30-day mortality in patients with carbapenem-resistant Acinetobacter baumannii during an outbreak in an intensive care unit. Epidemiology and Infection, 139(3): 411-418.
Santimaleeworagun, W., Wongpoowarak, P., Chayakul, P., Pattharachayakul, S., Tansakul, P., and Garey, K. W. (2011a). Clinical outcomes of patients infected with carbapenem-resistant Acinetobacter baumannii treated with single or combination antibiotic therapy. Journal of the Medical Association of Thailand, 94(7): 863-870.
Santimaleeworagun, W., Wongpoowarak, P., Chayakul, P., Pattharachayakul, S., Tansakul, P., and Garey, K. W. (2011b) In vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against clinical isolates of carbapenem-resistant Acinetobacter baumannii producing OXA-23 carbapenemases. Southeast Asian Journal of Tropical Medicine and Public Health, 42(4): 890-900.
Sheng, W. H., Liao, C. H., Lauderdale, T. L., Ko, W. C., Chen, Y. S., Liu, J. W., Lau, Y. J., Wang, L. H., Liu, K. S., Tsai, T. Y., Lin, S. Y., Hsu, M. S., Hsu, L. Y., and Chang, S. C. (2010). A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii. International Journal of Infectious Diseases 14(9): e764-e769.
Thapa, B., Tribuddharat, C., Srifuengfung, S., and Dhiraputra, C. (2010). High prevalence of bla(OXA)-23 in oligoclonal carbapenem-resistant Acinetobacter baumannii from Siriraj Hospital, Mahidol University, Bangkok, Thailand. Southeast Asian Journal of Tropical Medicine and Public Health, 41(3): 625-635.
Wisplinghoff, H., Bischoff, T., Tallent, S. M., Seifert, H., Wenzel, R. P., and Edmond, M. B. (2004). Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical Infectious Diseases, 39(3): 309-317.