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Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing
Mohammadreza Salehi1, Sirous Jafari2, Lida Ghafouri3
1Department of Infectious Diseases, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. salehi.mohamad3@gmail.com.
Introduction:
Ventilator-associated pneumonia (VAP) has been considered as a healthcare-associated infection with high mortality. Acinetobacter baumannii and Klebsiella pneumoniae are the common causes of VAPs around the world.
Methodology:
This research was a retrospective observational study in the intensive care unit (ICU) in a tertiary referral collegiate hospital in Tehran between March 2016 and May 2018. Patients who fulfilled VAP due to documented Multidrug Resistant Acinetobacter baumannii (MDR-AB) or Extended Spectrum Beta Lactamase-producing Klebsiella pneumoniae (ESBL-KP) criteria were enrolled. General demographic features, duration of hospital stay, antimicrobial treatment regimens, duration of ICU admission, the period of mechanical ventilation (MV) and 30-day mortality were documented and compared.
Results:
210 patients were found with clinical, microbiological and radiological evidence of VAP. In total, 76 patients with MDR-AB and 76 patients with ESBL-KP infections were matched in the final analysis. Duration of hospitalization in the patients with MDR-AB was significantly more than that of patients infected with ESBL-KP (p-value: 0.045). Patients diagnosed with MDR-AB VAP had a 65.8% mortality rate compared to 42.1% in the ESBL-KP infection group (p = 0.003).
Conclusions:
Results of the present study demonstrated that VAPs caused by MDR-AB may be more hazardous than ESBL-KP VAPs because they could be accompanied by a longer hospitalization course and even a higher mortality.
Insights
Ventilator-associated pneumonia (VAP) caused by Multidrug-Resistant Acinetobacter baumannii (MDR-AB) is linked to longer hospital stays and higher mortality compared to Extended Spectrum Beta-Lactamase-producing Klebsiella pneumoniae (ESBL-KP) VAP.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant healthcare-associated infection with high mortality rates.
- Acinetobacter baumannii and Klebsiella pneumoniae are leading global causes of VAP.
- Multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL) producing strains pose particular challenges.
Purpose of the Study:
- To compare the clinical outcomes of VAP caused by Multidrug-Resistant Acinetobacter baumannii (MDR-AB) versus Extended Spectrum Beta-Lactamase-producing Klebsiella pneumoniae (ESBL-KP).
- To identify risk factors and mortality associated with these specific VAP pathogens.
Main Methods:
- A retrospective observational study was conducted in an ICU from March 2016 to May 2018.
- Patients with VAP due to MDR-AB or ESBL-KP were identified and matched.
- Data collected included demographics, hospital stay, ICU duration, mechanical ventilation period, and 30-day mortality.
Main Results:
- 210 VAP cases were identified; 76 MDR-AB and 76 ESBL-KP patients were matched for analysis.
- Patients with MDR-AB VAP experienced significantly longer hospitalization (p=0.045).
- Mortality rates were higher for MDR-AB VAP (65.8%) compared to ESBL-KP VAP (42.1%, p=0.003).
Conclusions:
- MDR-AB VAP is associated with a more severe clinical course, including prolonged hospitalization.
- MDR-AB VAP presents a higher mortality risk than ESBL-KP VAP.
- These findings highlight the critical impact of pathogen resistance on VAP outcomes.
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