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Editorials |

Acinetobacter baumannii Infections in the ICU : Customization is the Key

Jordi Rello, MD, PhD (Barcelona, Spain)
Author and Funding Information

Staff physician, Intensive Care Department, Hospital de Sabadell.

Correspondence to: Jordi Rello, MD, PhD, Intensive Care Department, Hospital de Sabadell, Parc Tauli s/n, E08208 Sabadell, Barcelona, Spain; e-mail: jrello@CSPT.ES



Chest. 1999;115(5):1226-1229. doi:10.1378/chest.115.5.1226
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Extract

A review of several series1 indicates that Staphylococcus aureus and nonfermentative Gram-negative bacilli are the leading etiologic agents for ventilator-associated pneumonia (VAP). The incidence of S aureus and Pseudomonas aeruginosa is similar in the various series; the small differences depend on study population, exposure to antibiotics, and length of intubation. In contrast, the reported incidence of Acinetobacter baumannii varies widely: in three classical series of VAP using highly specific bronchoscopic techniques, Fagon et al,2 Rello et al,3 and Torres et al4 found A baumannii to be a cause of VAP in 9.5%, 3.5%, and 39.1% of episodes, respectively. The importance of nonfermentative Gram-negative bacilli as a cause of pneumonia is emphasized by the finding that these pathogens were responsible for 78.5% of deaths due to pneumonia with documented etiology in intubated patients.5 Using multivariate analysis, two studies67 found an independent association between this group of pathogens and death in a cohort of intubated patients. Whereas two matched case-control studies78 have demonstrated that VAP caused by P aeruginosa was associated with a significant excess of mortality, no such information is available for A baumannii.


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