Monobacterial versus polibacterial multidrug-resistant A.baumannii ventilator-associated pneumonia: prognostic factors of mortality : [pranešimas atspausdintas žurnale]

Abstract

INTRODUCTION. Clinical studies of VAP (e.g. Acinetobacter strain) use to be carried out despite of mono- or polibacterial origin [1]. It is not suppose to be constructed methodologically correctly if the aim of clinical issues is addressed to just one strain of polibacterial VAP. OBJECTIVES. To compare mortality prognostic factors of VAP due to multidrug-resistant A.baumannii (MDRAB) in case of mono- versus (vs) polibacterial origin. METHODS. Ongoing retrospective cohort study of patients (pts) treated in ICUs with MDRAB strains as pathogens of VAP during 2014-2016. RESULTS. Data of 164 pts were evaluated. Mono- vs polibacterial MDRAB VAP cases were found to be 77 (47 %) vs 87 (53%). Inhospital mortality of VAP due to MDRAB was 63,6% in mono- and 50,6% in polibacterial origin (p=0.115). Univariate analysis of survivors vs nonsurvivors in monobacterial MDRAB VAP: differences were found in medians of length of stay (LOS) after onset of VAP 26 days (d) (interquartile range (IQR) 19-61.5) vs 7 d (IQR 3-17), p< 0.001, SOFA score at the onset of VAP 5 (IQR 4-7) vs 8 (IQR 6-11), p=0.015, length of definitive antibacterial treatment 14 d (IQR 10-18) vs 7 d (IQR 4-13), p< 0.001, in means of oxygenation index 171.67 (SD 47.33) vs 145.56 (SD 60.65), p=0.042, SAPS II 41.27 (SD 12.24) vs 50.84 (SD 16.66), p=0.021 at ICU admission, and between proportions of previous hospitalization (≥2 d) in the preceding 90 d 11/46 (23.9%) vs 35/46 (76.1%), p=0.008, shock 17/58 (29.3%) vs 41/58 (70.7%), p=0.031, multiple organ dysfunction syndrome (MODS) 18/ 61 (29.5%) vs 43/61 (70.5%), p=0.019. Polibacterial MDRAB VAP: differences were found in medians of LOS after VAP diagnosis 29 d (IQR 14-39) vs 10.5 d (IQR 3.25-25.5), p< 0.001, SOFA score 5 (IQR 2-8) vs 8 (IQR 4-10), p=0.005 at the onset of VAP, length of definitive antibacterial treatment 14 d (IQR 9-17) vs 11.5 d (IQR 5-16), p=0.009, and between proportions of sepsis 36/79 (45.6%[...].