Clinical impact of pneumonia caused by Acinetobacter baumannii in intubated patients: a matched cohort study
Jose Garnacho1, Jordi Sole-Violan, Marcio Sa-Borges
1Hospital Universitario Virgen del Rocio, Seville, Spain.
Objective:
To determine whether ventilator-associated pneumonia caused by Acinetobacter baumannii (VAPAB) is associated with increased mortality rate.
Design:
A retrospective matched case-control study in which all intensive care unit adult patients with microbiologically documented VAPAB were defined as cases.
Setting:
Four intensive care units from teaching hospitals.
Patients:
Sixty patients were matched to sixty controls.
Measurements And Main Results:
Controls were matched based on stay before pneumonia onset, disease severity (Acute Physiology and Chronic Health Evaluation II) at admission, and diagnostic category. Population characteristics and intensive care unit mortality rates of patients with VAPAB and their controls were compared. Attributable mortality was determined by subtracting the crude mortality rate of the controls from the crude mortality rate of the case patients. Twenty-four of the 60 case patients died, representing a crude mortality rate of 40%, whereas 17 of the 60 controls died, a crude mortality rate of 28.3% (p =.17). Crude intensive care unit mortality was the same (12 of 35, 34.2%) in patients with VAPAB caused by strains sensitive to imipenem and in their matched controls. It was 44% for the 25 patients with imipenem-resistant strains with an estimated attributable mortality rate of 20.0% (95% confidence interval, -5.6% to 45.7%). Mean intensive care unit stay of patients and controls was 35.3 and 36.6 days, respectively (p = nonsignificant).
Conclusion:
In intubated patients, pneumonia by A. baumannii is not significantly associated with attributable mortality rate or an increased length of intensive care unit stay.
Insights
Ventilator-associated pneumonia caused by Acinetobacter baumannii (VAPAB) in intubated patients does not significantly increase mortality. This study found no significant association between VAPAB and increased intensive care unit length of stay.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in intensive care units.
- Acinetobacter baumannii is a common pathogen causing VAP, often associated with antibiotic resistance.
- Understanding the impact of VAPAB on patient outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the association between ventilator-associated pneumonia caused by Acinetobacter baumannii (VAPAB) and increased mortality rates in adult intensive care unit patients.
- To determine if VAPAB leads to a longer intensive care unit (ICU) stay.
Main Methods:
- A retrospective matched case-control study was conducted.
- Sixty adult ICU patients with microbiologically confirmed VAPAB were matched with sixty control patients.
- Controls were selected based on ICU stay duration before pneumonia onset, disease severity (APACHE II), and diagnostic category.
Main Results:
- The crude mortality rate for VAPAB cases was 40% (24/60), compared to 28.3% (17/60) for controls (p = 0.17).
- For VAPAB caused by imipenem-resistant strains, the mortality rate was 44%, with an estimated attributable mortality of 20.0%.
- There was no significant difference in mean ICU length of stay between VAPAB patients (35.3 days) and controls (36.6 days).
Conclusions:
- Ventilator-associated pneumonia caused by Acinetobacter baumannii is not significantly associated with an increased attributable mortality rate in intubated patients.
- VAPAB does not significantly increase the length of intensive care unit stay.
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