Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Characteristics and Prognosis of Acinetobacter Nosocomial Pneumonia between MDR and non-MDR

Acinetobacter 병원내 폐렴에서 다제 내성군과 약제 감수성군 간의 임상적 특징과 예후

  • Park, In-Il (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Kim, Ick-Keun (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Koo, Hyun-Cheol (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Han, Jae-Pil (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Kim, Young-Mook (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Lee, Myung-Goo (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Jung, Ki-Suck (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine)
  • 박인일 (한림대학교 의과대학 내과학교실) ;
  • 김익근 (한림대학교 의과대학 내과학교실) ;
  • 구현철 (한림대학교 의과대학 내과학교실) ;
  • 한재필 (한림대학교 의과대학 내과학교실) ;
  • 김영묵 (한림대학교 의과대학 내과학교실) ;
  • 이명구 (한림대학교 의과대학 내과학교실) ;
  • 정기석 (한림대학교 의과대학 내과학교실)
  • Received : 2006.05.11
  • Accepted : 2006.06.21
  • Published : 2006.07.30
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Abstract

Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was $69{\pm}11$ years old and the latter was $70{\pm}13$ years old. The mean APCHE II score, ICU days and mortality were not different between the two groups ($16.1{\pm}5.4$ vs. $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs. $39.1{\pm}31.0$, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

연구 배경: A. baumannii는 전 세계적으로 중요한 병원 내 병원균으로 부각되고 있고 이들 균에 의한 감염 또한 빠르게 증가하고 있다. 이들 감염에 연관된 사망률(균혈증:52%, 폐렴:23-73%)은 매우 높고 다제 내성은 비교적 흔하게 발생하고 있는 실정이다. 그러므로 다제 내성 A. baumannii 감염에 대한 효과적인 치료를 위해서 이들의 임상 특징과 결과를 분석하고 이해하는 것이 필요하다. 이에 본 연구는 A. baumannii 병원내 폐렴 중 다제 내성군과 약제 감수성군 간의 임상적 특징, 사망률, 이환율을 비교하였다. 방 법: 2002년 1월 1일부터 2004년 11월 1일까지 춘천성심병원에 입원했던 환자 중 Acinetobacter 병원 내 폐렴으로 판단되는 47명의 환자를 연구 대상으로 하였고 이들의 의무기록을 후향적으로 분석하였다. 본 연구에서는 다제 내성 A. baumannii를 실험 환경에서 A. baumannii에 효과적이며 상업적으로 이용할 수 있는 모든 항생제에 내성을 보이는 것으로 정의하였다. 결 과: 47명의 A. baumannii 병원내 폐렴 환자 중 17명이 다제 내성군, 30명이 약제 감수성군으로 분류되었다. 이들의 평균 연령은 다제 내성군은 $69{\pm}11$세, 약제 감수성군 $70{\pm}13$세이었고 APACHE II 점수, 중환자실 입원기간, 사망률에 있어서 두 군간에 유의한 차이는 없었다($16.1{\pm}5.4$ vs $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs $39.1{\pm}31.0$, P=0.2, 58.8% vs 40%, P=0.21). 결 론: Acinetobacter baumannii 다제 내성군과 약제 감수성군 간의 사망률과 임상적 특징 사이에서 유의한 차이는 보이지 않았다. 그러나 양군 모두 사망률과 이환율은 높게 나타나 A. baumannii 감염의 효과적인 감시 및 조절이 지속적으로 필요하겠다.

Keywords

References

  1. Allen DM, Hartman BJ. Chapter 209. Acinetobacter species. In: Mandell GL, Bennett JL, Dolin R, editors. Mandell, Douglas, and Bennett's principles and practice of infectious disease. 5th ed. Philadelphia: Churchill Livingstone; 2000. p. 2339-43
  2. Bergogne-Berezin E. The increasing role of Acinetobacter species as nosocomial pathogens. Curr Infect Dis Rep 2001;3:440-4 https://doi.org/10.1007/BF03160479
  3. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance(NNIS) report: data summary from October 1986-April 1996, issued May 1996. Am J infect Control 1996;24:380-8 https://doi.org/10.1016/S0196-6553(96)90026-7
  4. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999;27:887-92 https://doi.org/10.1097/00003246-199905000-00020
  5. Bergogne-Berezin E. The increasing significance of outbreaks of Acinetobacter spp.: the need for control and new agents. J Hosp Infect 1995;30(Suppl):441-52 https://doi.org/10.1016/0195-6701(95)90048-9
  6. Bergogne-Berezin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbial, clinical, and epidemiological features. Clin Microbiol Rev 1996;9: 148-65
  7. Getchell-White SI, Donowitz LG, Groschel DH. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol 1989;10:402-7 https://doi.org/10.1086/646061
  8. Manikal VM, Landman D, Saurina G, Oydna E, Lal H, Quale J. Endemic carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101-6 https://doi.org/10.1086/313902
  9. el Shafie SS, Alishaq M, Leni Garcia M. Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit. J Hosp Infect 2004;56:101-5 https://doi.org/10.1016/j.jhin.2003.09.024
  10. Acar JF. Consequences of bacterial resistance to antibiotics in medical practice. Clin Infect Dis 1997; 24(Suppl):S17-8 https://doi.org/10.1093/clinids/24.Supplement_1.S17
  11. Ayan M, Durmaz R, Aktas E, Durmaz B. Bacteriological, clinical and epidemiological characteristics of hospital-acquired Acinetobacter baumannii infection in a teaching hospital. J Hosp Infect 2003;54: 39-45 https://doi.org/10.1016/S0195-6701(03)00076-8
  12. Landman D, Quale JM, Mayorga D, Adedeji A, Vangala K, Ravishankar J, et al. Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Psuedomonas aeruginosa in Brooklyn, NY. Arch Intern Med 2002;162:1515-20 https://doi.org/10.1001/archinte.162.13.1515
  13. Beck-Sague CM, Jarvis WR, Brook JH, Culver DH, Potts A, Gray E, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol 1990;132:723-33 https://doi.org/10.1093/oxfordjournals.aje.a115714
  14. Seifert H, Strate A, Pulverer G. Nosocomial bacteremia due to Acinetobacter baumannii: clinical features, epidemiology, and predictors of mortality. Medicine 1995;74:340-9 https://doi.org/10.1097/00005792-199511000-00004
  15. Cisneros JM, Reyes MJ, Pachon J, Becerril B, Caballero FJ, Garcia-Garmendia JL, et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996;22:1026-32 https://doi.org/10.1093/clinids/22.6.1026
  16. Fagon JY, Chastre J, Domart Y, Trouillet JL, Gibert C. Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a proctected specimen brush. Clin Infect Dis 1996;23:538-42 https://doi.org/10.1093/clinids/23.3.538
  17. Garcia-Garmendia JL, Ortiz-Leyba C, Garacho- Monero J, Jimenez-Jimenez FJ, Perez- Parede C, Barrero-Almodovar AE, et al. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis 2001; 33:939-46 https://doi.org/10.1086/322584
  18. Go ES, Urban C, Burns J, Kreiswirth B, Eisner W, Mariano N, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:1329-32 https://doi.org/10.1016/S0140-6736(94)90694-7
  19. Mahgoub S, Ahmed J, Glatt AE. Completely resistant Acinetobacter baummannii strains. Infect Control Hosp Epidemiol 2002;23:477-9 https://doi.org/10.1086/502091
  20. Simor AE, Lee M, Vearnocombe M, Jones-Paul L, Barry C, Gomez M, et al. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management. Infect Control Hsop Epidemiol 2002;23:261-7 https://doi.org/10.1086/502046
  21. Wong TH, Tan BH, Ling ML, Song C. Multi-resistant Acinetobacter baumannii on a burn unit: clinical risk factors and prognosis. Burns 2002;28:349-57 https://doi.org/10.1016/S0305-4179(02)00012-8
  22. Husni RN, Goldstein LS, Arroliga AC, Hall GS, Fatica C, Stoller JK, et al. Risk factors for an outbreak of Multidrug-resistant Acinetobacter nosocomial pneumonia among intubated patient, Chest 1999;115:1378-82 https://doi.org/10.1378/chest.115.5.1378
  23. Abbo A, Navon-Venezia S, Hammer-Muntz S, Krichali T, Siegaman-Igra Y, Carmeli Y. Multidrugresistant Acinetobacter baumannii. Emerg Infect Dis 2005;11:22-9 https://doi.org/10.3201/eid1101.040001
  24. Koeleman JG, Parleviest GA, Dijkshoorn L, Savelkoul PH, Vandengroucke-Grauls CM. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition. J Hosp Infect 1997;37:113-23 https://doi.org/10.1016/S0195-6701(97)90181-X
  25. Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 1995;20:790-6 https://doi.org/10.1093/clinids/20.4.790
  26. Lee SO, Kim NJ, Choi SH, Kim TH, Chung JW, Woo JH, et al. Risk factors for acquisition of imipenemresistant Acinetobacter baumnnii: a case-control study. Antimicrob Agents Chemother 2004;48:224-8 https://doi.org/10.1128/AAC.48.1.224-228.2004
  27. Husni RN, Goldstein LS, Arroliga AC, Hall GS, Fatica C, Stoller JK, et al. Risk factors for an outbreak of multidrug-resistant Acinetoacter nosocomial pneumonia among intubated patients. Chest 1999;115:1378-82 https://doi.org/10.1378/chest.115.5.1378
  28. Jain R, Danziger LH. Multidrug-resistant Acinetobacter infection: an emerging challenge to clinicians. Ann Pharmacother 2004;38:1449-59 https://doi.org/10.1345/aph.1D592
  29. del Mar Tomas M, Cartelle M, Pertega S, Beceiro A, Linares P, Canle D, et al. Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonization and infection. Clin Microbiol Infect 2005;11;540-6 https://doi.org/10.1111/j.1469-0691.2005.01184.x
  30. Lee SW, Jo HS, Kim WJ. Clinical characteristics of intensive care unit patients with carbapenem resistant Acinetobacter baumannii isolated from sputum. Tuberc Respir Dis 2006;60:228-34 https://doi.org/10.4046/trd.2006.60.2.228
  31. Mahanthanapak S, Chaiwarith R, Supparatpinyo K. Pan-drug resistant Acinetobacter baumannii at Maharaj Nakorn Chiang Mai Hospital. 5th International Symposium on Antimicrobial Agents and Resistance. 2005;210. Abstract
  32. Gomez J, Simarro E, Banos V, Requena L, Ruiz F, Garcia M, et al. Six-year prospective study of risk and progonositc factors in patients with nosocomial sepsis caused by Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 1999;18:358-61 https://doi.org/10.1007/PL00015019
  33. Brun-Buisson C, Doyon F, Carlet J. Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. Am J Respir Crit Care Med 1996;154:617-24 https://doi.org/10.1164/ajrccm.154.3.8810595