Document Detail


Antimicrobial treatment and clinical outcome for infections with carbapenem- and multiply-resistant Acinetobacter baumannii around London.
MedLine Citation:
PMID:  19910162     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Carbapenem- and multiply-resistant Acinetobacter baumannii (C-MRAB) are challenging pathogens, often susceptible only to polymyxins and tigecycline. We reviewed clinical outcomes in relation to antibiotic treatment for 166 consecutive patients infected or colonised with these organisms at 18 hospitals around London, UK. Clinical data were obtained along with the isolates, which were typed by pulsed-field gel electrophoresis (PFGE). Outcomes were compared for colonised and infected patients and in relation to treatment, with associations examined by logistic regression. Most subjects (103/166; 62%) were in Intensive Care Units (ICUs) or high dependency units; 84 (50.6%) were judged to be infected and 73 (44.0%) were colonised, with 9 indeterminate. Among the 166 C-MRAB isolates, 141 belonged to OXA-23 clone 1, a European clone II lineage. Survival rates among infected and colonised patients were 68% and 67%, respectively (P > 0.05), indicating little attributable mortality. Univariate and multivariate analyses indicated poorer outcomes among ICU-infected patients and those with pulmonary infection or bacteraemia, whereas trauma patients had significantly better outcomes than the generality. Outcomes varied with hospital, even in multivariate analysis, reflecting either differences in management or case mix. There was little association between outcome and therapy with colistin and/or tigecycline except that, among patients with respiratory infection, 12/15 treated with intravenous colistin alone had poor outcome compared with 1/8 whose therapy include nebulised colistin. This difference was significant (P=0.003), although the patients receiving nebulised drug were mostly younger, included trauma cases and were at a hospital with good outcomes.
Authors:
David M Livermore; Robert L R Hill; Hazel Thomson; Andr?? Charlett; Jane F Turton; Rachel Pike; Bharat C Patel; Rohini Manuel; Stephen Gillespie; Indran Balakrishnan; Stephen P Barrett; Nigel Cumberland; Mary Twagira;
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-11
Journal Detail:
Title:  International journal of antimicrobial agents     Volume:  35     ISSN:  1872-7913     ISO Abbreviation:  Int. J. Antimicrob. Agents     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-07     Completed Date:  2010-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111860     Medline TA:  Int J Antimicrob Agents     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  19-24     Citation Subset:  IM    
Affiliation:
Antibiotic Resistance Monitoring & Reference Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. david.livermore@hpa.org.uk
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MeSH Terms
Descriptor/Qualifier:
Acinetobacter Infections / drug therapy*,  microbiology
Acinetobacter baumannii / classification,  drug effects,  genetics,  isolation & purification*
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / pharmacology,  therapeutic use*
Bacterial Typing Techniques
Cluster Analysis
DNA Fingerprinting
DNA, Bacterial / genetics
Drug Resistance, Multiple, Bacterial*
Electrophoresis, Gel, Pulsed-Field
Female
Genotype
Hospitals
Humans
London
Male
Middle Aged
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
//Department of Health
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/DNA, Bacterial
Investigator
Investigator/Affiliation:
B S Azadian / ; L Bain / ; A S Breathnach / ; J Hartley / ; H Roberts / ; A Jepson / ; P Kumari / ; J B Leach / ; G Rao / ; B Cherian / ; M Kelsey / ; Peter Wilson /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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