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The Distribution of Multidrug-resistant Microorganisms and Treatment Status of Hospital-acquired Pneumonia/Ventilator-associated Pneumonia in Adult Intensive Care Units: a Prospective Cohort Observational Study

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Abstract
Background: It is essential to determine the distribution of the causative microorganisms in the region and the status of local antibiotic resistance for the proper treatment of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP). This study aimed to investigate the occurrence and causative strains of HAP/VAP, distribution of resistant bacteria, use of antibiotics, and the ensuing outcomes of patients in Korea.

Methods: A multicenter prospective observational cohort study was conducted among patients with HAP/VAP admitted to the medical intensive care unit of 5 tertiary referral centers between August 2012 and June 2015. Patients' demographic and clinical data were collected.

Results: A total of 381 patients were diagnosed with HAP/VAP. Their median age was 69 (59-76) years and 71% were males. A majority of the patients (88%) had late-onset (> 5 days) HAP/VAP. One-quarter of the patients (n = 99) had at least one risk factor for multidrug-resistant (MDR) pathogens, such as prior intravenous antibiotic use within the last 90 days. Microbiological specimens were mostly obtained noninvasively (87%) using sputum or endotracheal aspirates. Pathogens were identified in 235 (62%) of the 381 patients. The most common bacterial pathogen was Acinetobacter baumannii (n = 89), followed by Staphylococcus aureus (n = 52), Klebsiella pneumoniae ( n = 25) and Pseudomonas aeruginosa (n = 22). Most of isolated A. baumannii (97%) and S. aureus (88%) were multidrug resistant. The most commonly used empirical antibiotic regimens were carbapenem-based antibiotics (38%), followed by extended-spectrum penicillin/beta-lactamase inhibitor (34%). Glycopeptide or linezolid were also used in combination in 54% of patients. The 28-day mortality rate of the patients with HAP/VAP was 30% and the 60-day mortality was 46%. Patients who used empirical antibiotics appropriately had significantly lower mortality rates than those who did not (28-day mortality: 25% vs. 40%, P= 0.032; 60-day mortality: 41% vs. 55%, P= 0.032, respectively). Administration of appropriate empirical antibiotics (odds ratio [OR], 0.282; confidence interval [CI], 0.092-0.859; P= 0.026), Day 7 treatment failure (OR, 4.515; CI, 1.545-13.192; P= 0.006), and APACHE II score on day 1 (OR, 1.326; CI, 0.988-1.779; P= 0.012) were the factors that determined the 28-day mortality in patients with HAP who had identified bacteria as pathogens.

Conclusion: In HAP/VAP patients, there was a large burden of MDR pathogens, and their associated mortality rate was high. Proper selection of empirical antibiotics was significantly associated with the patient's prognosis; however, there was a discrepancy between major pathogens and empirical antibiotic therapy.
Author(s)
Youjin ChangKyeongman JeonSang-Min LeeYoung-Jae ChoYoung Sam Kim정용필홍상범
Issued Date
2021
Type
Article
Keyword
DrugResistanceBacterialHealthcare-associated PneumoniaIntensiveCare UnitsTreatment OutcomeVentilator-associated Pneumonia
DOI
10.3346/jkms.2021.36.e251
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7185
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9873283&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,The%20Distribution%20of%20Multidrug-resistant%20Microorganisms%20and%20Treatment%20Status%20of%20Hospital-acquired%20Pneumonia%2FVentilator-associated%20Pneumonia%20in%20Adult%20Intensive%20Care%20Units:%20a%20Prospective%20Cohort%20Observational%20Study&offset=0&pcAvailability=true
Publisher
JOURNAL OF KOREAN MEDICAL SCIENCE
Location
대한민국
Language
영어
ISSN
1011-8934
Citation Volume
36
Citation Number
41
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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