Abstract
Acinetobacter baumannii (AB) is an emerging cause of nosocomial outbreaks. Multidrug resistance (MDR) strains, only colistin (PxE) sensitive are a matter of concern. Objectives: The purpose of this study was to compare the effectiveness and risks of aerosolized (AS) versus intravenous (IV) PxE in patients with MDR AB pneumonia (Pn).
Methods: A retrospective unicentric analysis of respiratory MDR AB isolates from January of 2009 to June of 2013. Of the 680 MDR AB isolates retrieved by the database, we selected patients treated with AS and/or IV PxE. The primary end-point was all-cause mortality and the safety end-point was renal function.
Results: Of the 139 patients with MDR AB Pn 50 (36,5%) died during hospitalization; 96 (70,1%) were men; 42 (30,7%) had COPD, 11 (8%) had bronchiectasis, 23 (16,8%) had active cancer and 4 (2,9%) were on dialysis. The mean age was 69,6 years; mean length of stay was 51,1 days; 116 (84,7%) patients were treated with IV PxE alone and 21 (15,3%) patients had AS PxE. IV PxE, creatinine increase, dialysis, and treatment failure during hospitalization were associated with higher mortality (all p<0,05). Patients on IV PxE had higher rates of renal, treatment failure and death rates (all p<0,05).
Conclusion: Our results demonstrate that AB is associated with prolonged hospital stay and high mortality rates. Renal function deterioration and treatment failure are associated with increased mortality, and these findings occur more often in IV PXE . These results should encourage clinicians to include inhaled colistin in the treatment of patients with AB pneumonia and are a step forward in the treatment of this MDR pathogen.
- © 2014 ERS