PURPOSE: To determine the characteristics of patients with nosocomial pneumonia due to Acinetobacter baumanii in Intensive care Unit (ICU) of a tertiary care teaching hospital.
METHODS: From January 2004 to December 2005, all patients with nosocomial pneumonia and positive respiratory culture to Acinetobacter baumanii in ICU of Makassed General Hospital (MGH) were reviewed. The following information were collected from medical records: age, sex, admitting diagnosis, concomitant illnesses, antibiotics sensitivity, length of stay (LOS), mechanical ventilation (MV) status and duration, presence of risk factors (TPN, steroids intake and central venous catheters), antibiotics taken prior to the pneumonia and mortality. Chi-square test was used to compare survivals and non-survivals. A p-value< 0.05 was considered statistically significant.
RESULTS: Out of 48 cases collected, 42 were available for review. These were 25 males (59%) and 17 females (41%). The average age was 63.3+17.2 years. The average hospital LOS was 44.1+29.6 days. Forty patients out of 42 (95%) were on mechanical ventilation, with an average duration of 34.0+28.8 days. The average duration from ICU admission and from starting MV to Acinetobacter positive culture was 15.5+11.1 and 11.7+11.4 days respectively. Five patients out of 42 were on systemic steroids, 69.0% of patients had central venous catheters. The cultures were polymicrobial in 11/42 patients (26.2%). Four patients had bacteremia due to Acinetobacter baumanii as well. The Acinetobacter was multi-drug resistant in 63.1% of cases with susceptibility to Colistin only. The mortality rate was 64.3%. Survival curve is shown in figure-1. When survivals were compared to non-survivals the only statistically significant differences were age, 50.6+15.4 vs. 70.2+14.0; and duration of MV, 26.8+22.5 vs. 37.8+31.4 respectively.
CONCLUSION: Most of the Acinetobacter baumanii nosocomial pneumonia cases were in the category of ventilator associated pneumonia (VAP). It carried a high mortality rate. The high prevalence of only Colistin sensitive Acinetobacter raised the possibility of monoclonal outbreak in our ICU.
CLINICAL IMPLICATIONS: Infection control strategies should be developed to control this emerging serious nosocomial pathogen.
DISCLOSURE: Hani Lababidi, None.