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Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy.

Abstract <b>Introduction.</b> Multi-resistant Acinetobacter baumannii isolated from patients has become one of the most hazardous pathogens in health care settings. The aim of the study was to analyze pneumonia caused by Acinetobacter baumannii in patients hospitalized because of exacerbation of chronic obstructive pulmonary diseases (COPD), who were admitted to the Pulmonology Ward of the Masovian Specialistic Hospital in Radom (MSS). The incidence and drug sensitivity of these non-fermenting rods were evaluated, and compliance with antimicrobial procedure with the algorithm of the guidelines in applicable recommendations, was estimated. This should result in determining the local patterns of resistance and verifying therapeutic procedures in accordance with the assumptions of hospital antibiotic policy. In addition, the study examined the effectiveness of empiric and targeted therapy according to the clinical condition of the patient, and the eradication of A. baumannii, in comparison with the aggravating factors of the patient. <b>Materials and Method.</b> The retrospective study included 90 patients with exacerbation of COPD whose etiological factor of infection was A. baumannii, hospitalized in the Department of Pulmonology (MSS) in 2012-2016. <b>Results.</b> Studies were conducted on 90 patients with COPD exacerbation from which A. baumannii was isolated. Co-infections with other bacterial species among 41 patients were additionally noted. The majority of A. baumannii strains showed a high resistance (90%) to fluoroquinolones, ceftazidime, piperacillin/tazobactam. For strains causing a co-infection, drug resistance was successively 44-56%, 44%, 44%. All of patients received empirical therapy. The most commonly used drug was amoxicillin with a clavulanic acid, often combined with fluoroquinolone. This type of therapy was effective among 10% of patients. The mortality in this group was determined at 29%. Among 79% of patients with COPD, a targeted therapy was performed which proved to be effective in 58% of treated cases by susceptibility testing. The highest efficacy was observer after the use of colistin and carbapenems. <b>Conclusion.</b> In the performed study, the infections caused by multi-resistant Acinetobacter baumannii, were observed in COPD, which should be taken into consideration in choosing empirical antibiotic therapy. Simultaneously, the local resistance patterns of multi-drug-resistant (MDR) Gram-negative strains co-infecting COPD should be considered in empirical treatment. Moreover, both additional clinical complication and co-infections contribute to a more severe course of diseases. In this study, the mortality percent exceeded 29%.
PMID
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Authors

Mayor MeshTerms
Keywords

Acinetobacter baumannii

COPD

antibiotics

co-infection

multidrug-resistant strains

Journal Title annals of agricultural and environmental medicine : aaem
Publication Year Start




PMID- 28664714
OWN - NLM
STAT- MEDLINE
DA  - 20170630
DCOM- 20170710
LR  - 20170713
IS  - 1898-2263 (Electronic)
IS  - 1232-1966 (Linking)
VI  - 24
IP  - 2
DP  - 2017 Jun 12
TI  - Analysis of Acinetobacter baumannii resistance patterns in patients with chronic 
      obstructive pulmonary disease (COPD) in terms of choice of effective empiric
      antibiotic therapy.
PG  - 307-311
LID - 74710 [pii]
AB  - &lt;b&gt;Introduction.&lt;/b&gt; Multi-resistant Acinetobacter baumannii isolated from
      patients has become one of the most hazardous pathogens in health care settings. 
      The aim of the study was to analyze pneumonia caused by Acinetobacter baumannii
      in patients hospitalized because of exacerbation of chronic obstructive pulmonary
      diseases (COPD), who were admitted to the Pulmonology Ward of the Masovian
      Specialistic Hospital in Radom (MSS). The incidence and drug sensitivity of these
      non-fermenting rods were evaluated, and compliance with antimicrobial procedure
      with the algorithm of the guidelines in applicable recommendations, was
      estimated. This should result in determining the local patterns of resistance and
      verifying therapeutic procedures in accordance with the assumptions of hospital
      antibiotic policy. In addition, the study examined the effectiveness of empiric
      and targeted therapy according to the clinical condition of the patient, and the 
      eradication of A. baumannii, in comparison with the aggravating factors of the
      patient. &lt;b&gt;Materials and Method.&lt;/b&gt; The retrospective study included 90
      patients with exacerbation of COPD whose etiological factor of infection was A.
      baumannii, hospitalized in the Department of Pulmonology (MSS) in 2012-2016.
      &lt;b&gt;Results.&lt;/b&gt; Studies were conducted on 90 patients with COPD exacerbation from
      which A. baumannii was isolated. Co-infections with other bacterial species among
      41 patients were additionally noted. The majority of A. baumannii strains showed 
      a high resistance (90%) to fluoroquinolones, ceftazidime,
      piperacillin/tazobactam. For strains causing a co-infection, drug resistance was 
      successively 44-56%, 44%, 44%. All of patients received empirical therapy. The
      most commonly used drug was amoxicillin with a clavulanic acid, often combined
      with fluoroquinolone. This type of therapy was effective among 10% of patients.
      The mortality in this group was determined at 29%. Among 79% of patients with
      COPD, a targeted therapy was performed which proved to be effective in 58% of
      treated cases by susceptibility testing. The highest efficacy was observer after 
      the use of colistin and carbapenems. &lt;b&gt;Conclusion.&lt;/b&gt; In the performed study,
      the infections caused by multi-resistant Acinetobacter baumannii, were observed
      in COPD, which should be taken into consideration in choosing empirical
      antibiotic therapy. Simultaneously, the local resistance patterns of
      multi-drug-resistant (MDR) Gram-negative strains co-infecting COPD should be
      considered in empirical treatment. Moreover, both additional clinical
      complication and co-infections contribute to a more severe course of diseases. In
      this study, the mortality percent exceeded 29%.
FAU - Grochowalska, Aneta
AU  - Grochowalska A
AD  - Laboratory of Microbiology, Masovian Specialistic Hospital in Radom, Radom,
      Poland. [email protected]
FAU - Koziol-Montewka, Maria
AU  - Koziol-Montewka M
AD  - Pope John II State School of Higher Education in Biala Podlaska, Biala Podlaska, 
      Poland.
FAU - Sobieszczanska, Anna
AU  - Sobieszczanska A
AD  - Chair and Department of Jaw Orthopaedics, Medical University in Lublin, Lublin,
      Poland.
LA  - eng
PT  - Journal Article
DEP - 20170525
PL  - Poland
TA  - Ann Agric Environ Med
JT  - Annals of agricultural and environmental medicine : AAEM
JID - 9500166
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Quinolines)
RN  - 23521W1S24 (Clavulanic Acid)
RN  - 804826J2HU (Amoxicillin)
RN  - E66400VT9R (quinoline)
SB  - IM
MH  - Acinetobacter Infections/*drug therapy/microbiology
MH  - Acinetobacter baumannii/*drug effects/physiology
MH  - Aged
MH  - Aged, 80 and over
MH  - Amoxicillin/administration &amp; dosage
MH  - Anti-Bacterial Agents/*administration &amp; dosage
MH  - Clavulanic Acid/administration &amp; dosage
MH  - Drug Resistance, Bacterial
MH  - Female
MH  - Hospitalization
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Disease, Chronic Obstructive/*drug therapy/microbiology
MH  - Quinolines/administration &amp; dosage
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Acinetobacter baumannii
OT  - COPD
OT  - antibiotics
OT  - co-infection
OT  - multidrug-resistant strains
EDAT- 2017/07/01 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/07/01 06:00
AID - 74710 [pii]
PST - ppublish
SO  - Ann Agric Environ Med. 2017 Jun 12;24(2):307-311. Epub 2017 May 25.