Impact of empirical antimicrobial therapy on the outcome of critically ill patients with Acinetobacter bacteremia

Hasan M Al-Dorzi; Abdulaziz M Asiri; Abdullah Shimemri; Hani M Tamim; Sameera M Al Johani; Tarek Al Dabbagh; Yaseen M Arabi

doi:10.4103/1817-1737.164302

Official publication of the Saudi Thoracic Society, affiliated to King Saud University

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ORIGINAL ARTICLE

Year : 2015 | Volume : 10 | Issue : 4 | Page : 256-262

Impact of empirical antimicrobial therapy on the outcome of critically ill patients with Acinetobacter bacteremia

Hasan M Al-Dorzi¹, Abdulaziz M Asiri¹, Abdullah Shimemri¹, Hani M Tamim², Sameera M Al Johani³, Tarek Al Dabbagh¹, Yaseen M Arabi¹
¹ Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
² Department of Epidemiology and Biostatistics, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
³ Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Correspondence Address:
Hasan M Al-Dorzi
Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, PO Box 22490, Mail Code 1425, Riyadh 11426
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1817-1737.164302

Rationale: Empirical antimicrobial therapy (EAT) for Acinetobacter infections may not be appropriate as it tends to be multidrug-resistant. This study evaluated the relationship between appropriate EAT and the outcomes of Intensive Care Unit (ICU) patients with Acinetobacter bacteremia. Methods: This is a retrospective study of patients admitted to a medical-surgical ICU (2005-2010) and developed Acinetobacter bacteremia during the stay. Patients were categorized according to EAT appropriateness, defined as administration of at least one antimicrobial agent to which the Acinetobacter was susceptible before susceptibility results were known. The relation between EAT appropriateness and outcomes was evaluated. Results: Sixty patients developed Acinetobacter bacteremia in the 6-year period (age = 50 ± 19 years; 62% males; Acute Physiology and Chronic Health Evaluation II score = 28 ± 9; 98.3% with central lines; 67% in shock and 59% mechanically ventilated) on average on day 23 of ICU and day 38 of hospital stay. All isolates were resistant to at least three of the tested antimicrobials. Appropriate EAT was administered to 60% of patients, mostly as intravenous colistin. Appropriate EAT was associated with lower ICU mortality risk (odds ratio: 0.15; 95% confidence interval: 0.03-0.96) on multivariate analysis. Conclusions: In this 6-year cohort, Acinetobacter bacteremia was related to multidrug-resistant strains. Appropriate EAT was associated with decreased ICU mortality risk.

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