Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 17 , ISSUE 3 ( June, 2013 ) > List of Articles


Carbapenem-resistant Acinetobacter ventilator-associated pneumonia: Clinical characteristics and outcome

Arvind Kumar Baronia, Ratender Kumar Singh, Bhaskar P. Rao

Keywords : Acinetobacter, carbapenem, intensive care unit, ventilator-associated pneumonia

Citation Information : Baronia AK, Singh RK, Rao BP. Carbapenem-resistant Acinetobacter ventilator-associated pneumonia: Clinical characteristics and outcome. Indian J Crit Care Med 2013; 17 (3):129-134.

DOI: 10.4103/0972-5229.117036

License: CC BY-ND 3.0

Published Online: 01-06-2014

Copyright Statement:  Copyright © 2013; The Author(s).


Objective: To study the clinical characteristics and 28-days mortality in patients with ventilator-associated pneumonia (VAP) due to carbapenem-resistant Acinetobacter (CRA). Design: Retrospective, observational, cohort study. Setting: Intensive care unit (ICU) of a university hospital. Materials and Methods: Microbiologically confirmed VAP due to CRA infection. Intervention: None. Results: Out of 87 patients with VAP due to CRA, 60 (69%) were male; whose median age was 51 years; 73 (84%) patients were medical; 26 (30%) had history of hospitalization in last 3 months; median acute physiology and chronic health evaluation (APACHE) II was 15 and median SOFA 9 at admission; primary reason for ICU admission was respiratory failure (34%); 46 (53%) patients had more than 2 organ failure at ICU admission; median length of ICU stay was 19 days; 66 (76%) patients need vasoactive agents during ICU stay, whereas 55 (63%) patients had renal failure; median duration of mechanical ventilation was 17 days; 22 (25%) patients had acute respiratory distress syndrome (ARDS) during ICU stay; 72 (83%) patients had exposure to carbapenem before inclusion in the study; 33 (38%) patients had same organism at other sites. In the follow-up, 47 (54%) patient survived at 28 days after having VAP; whereas only 40 (46%) patients were discharged from the hospital. Conclusions: CRA-VAP has high crude mortality. Advanced age; severity of illness and presence of pneumonia at ICU admission; and presence of shock, ARDS and renal failure have impact on outcome in these patients.

PDF Share
  1. Munoz-Price LS, Weinstein RA. Acinetobacter infection. N Engl J Med 2008;358:1271-81.
  2. Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis 2008;8:751-62.
  3. Falagas ME, Rafailidis PI. Attributable mortality of Acinetobacter baumannii: No longer a controversial issue. Crit Care 2007;11:134.
  4. Dizbay M, Tunccan OG, Sezer BE, Hizel K. Nosocomial imipenem-resistant Acinetobacter baumannii infections: Epidemiology and risk factors. Scand J Infect Dis 2010;42:741-6.
  5. Schimith Bier KE, Luiz SO, Scheffer MC, Gales AC, Paganini MC, Nascimento AJ, et al. Temporal evolution of carbapenem-resistant Acinetobacter baumannii in Curitiba, southern Brazil. Am J Infect Control 2010;38:308-14.
  6. Go ES, Urban C, Burns J, Kreiswirth B, Eisner W, Mariano N, et al. Clinical and molecular epidemiology of acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:1329-32.
  7. Manchanda V, Sinha S, Singh NP. Multidrug-resistant Acinetobacter. J Global Infect Dis 2010;2:291-304.
  8. Trottier V, Segura PG, Namias N, King D, Pizano LR, Schulman CI. Outcomes of Acinetobacter baumannii infection in critically ill burned patients. J Burn Care Res 2007;28:248-54.
  9. Mera RM, Miller LA, Amrine-Madsen H, Sahm DF. Acinetobacter baumannii 2002-2008: Increase of carbapenem-associated multiclass resistance in the United States. Microb Drug Resist 2010;16:209-15.
  10. Beijerinck MW. Uber pigmentbildungbei essigbakterien. Cent Bakteriol Parasitenk 1911;29:169-76.
  11. Gaynes R, Edwards JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005;41:848-54.
  12. Baran G, Erbay A, Bodur H, Ongürü P, Akinci E, Balaban N, et al. Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. Int J Infect Dis 2008;12:16-21.
  13. Lee SO, Kim NJ, Choi SH, Hyong Kim T, Chung JW, Woo JH, et al. Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii: A case-control study. Antimicrob Agents Chemother 2004;48:224-8.
  14. Kwon KT, Oh WS, Song JH, Chang HH, Jung SI, Kim SW, et al. Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia. J Antimicrob Chemother 2007;59:525-30.
  15. Curcio D, Fernández F, Vergara J, Vazquez W, Luna CM. Late onset ventilator-associated pneumonia due to multidrug-resistant Acinetobacter spp.: Experience with tigecycline. J Chemother 2009;21:58-62.
  16. Oliveira MS, Prado GV, Costa SF, Grinbaum RS, Levin AS. Ampicillin/sulbactam compared with polymyxins for the treatment of infections caused by carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother 2008;61:1369-75.
  17. Hernández-Torres A, García-Vázquez E, Gómez J, Canteras M, Ruiz J, Fernández-Rufete A, et al. [Carbapenem and multidrug-resistant Acinetobacter baumannii colonisation/infection: Epidemiology and factors associated with infection]. Med Clin (Barc) 2010;135:389-96.
  18. Asensio A, Cantón R, Vaqué J, Calbo-Torrecillas F, Herruzo R, Arribas JL, et al. [Prevalence of infection by carbapenem-resistant Acinetobacter baumannii in Spain (1999-2005)]. Enferm Infecc Microbiol Clin 2008;26:199-204.
  19. Prates CG, Martins AF, Superti SV, Lopes FS, Ramos F, Cantarelli VV, et al. Risk factors for 30-day mortality in patients with carbapenem-resistant Acinetobacter baumannii during an outbreak in an intensive care unit. Epidemiol Infect 2011;139:411-8.
  20. del Mar Tomas M, Cartelle M, Pertega S, Beceiro A, Llinares P, Canle D, et al. Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: Patient prognosis and risk-factors for colonisation and infection. Clin Microbiol Infect 2005;11:540-6.
  21. Munoz-Price LS, Zembower T, Penugonda S, Schreckenberger P, Lavin MA, Welbel S, et al. Clinical outcomes of carbapenem-resistant Acinetobacter baumannii bloodstream infections: Study of a 2-state monoclonal outbreak. Infect Control Hosp Epidemiol 2010;31:1057-62.
  22. Eberle BM, Schnüriger B, Putty B, Barmparas G, Kobayashi L, Inaba K, et al. The impact of Acinetobacter baumannii infections on outcome in trauma patients: A matched cohort study. Crit Care Med 2010;38:2133-8.
  23. Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: Risk factors for acquisition, infection and their consequences. J Hosp Infect 2007;65:204-11.
  24. Chan JD, Graves JA, Dellit TH. Antimicrobial treatment and clinical outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia. J Intensive Care Med 2010;25:343-8.
  25. Dizbay M, Altuncekic A, Sezer BE, Ozdemir K, Arman D. Colistin and tigecycline susceptibility among multidrug-resistant Acinetobacter baumannii isolated from ventilator-associated pneumonia. Int J Antimicrob Agents 2008;32:29-32.
  26. Sheng WH, Liao CH, Lauderdale TL, Ko WC, Chen YS, Liu JW, et al. A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii. Int J Infect Dis 2010;14:e764-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.