1. MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN RESPIRATORY INTENSIVE CARE UNIT Pervin Korkmaz Ekren 1, M. Sezai Tasbakan 1, Burcu Basarık 1, Husnu Pullukcu 2, Sohret Aydemir 3, Alev Gurgun 1, Ozen Kacmaz Basoglu 1, Feza Bacakoglu 1 Ege University School of Medicine Departments of 1 Chest Diseases, 2 Infection Disease and Clinic Microbiology, 3 Microbiology and Clinic Microbiology

2. 2 Nosocomial Infections (1) Multidrug-resistant (MDR) Gram-negative bacilli !!! Acinetobacter baumannii : - Developing of antimicrobial resistance is extremely rapid - This resistance is multiple Serious therapeutic problems

3. 3 Nosocomial Infections (2) Acinetobacter baumannii : - Bacteremia - Urinary tract infection - Secondary meningitis

4. 4 Nosocomial Infections (2) Acinetobacter baumannii : - Bacteremia - Urinary tract infection - Secondary meningitis - Nosocomial pneumonia In intensive care units (ICU) Role in ventilator-associated pneumonia (VAP) ↑

5. 5 Method Ege University, Department of Chest Diseases Respiratory ICU December 2005 – December 2007 218 patients 58 patients (26.6 % ) 37 patients included in this study MDR A.baumanni Infection (-) MDR A.baumanni Infection (+)

6. 6 Table 1. Severity of diseases and characteristics of patients with MDR A.baumannii infections Age (men year±SD)61.6 ±19.8 Gender (Male), n (%)21 (%56.8) DİAGNOSİS n, (%) CAP NP COPD PIP Lung TB OUAS ARDS Ampiema+pneumothorax Hemothorax Lung cancer 10 (% 27.0) 8 (% 21.6) 2 (% 5.4) 1 (% 2.7) Co-morbidty (var - %)81.1 İmmunsupreyon* (var - %)21.6 During last month (%); Hospitalization Antimicrobial therapy 70.3 51.6 APACHE II (mean±SD)20.6±6.9 PaO 2 /FiO 2 (mean±SD)213.1±89.5 Abbreviations: CAP= Community-acquired pneumoniae; NP= Nosocomial pneumoniae; COPD= Chronic obstructive lung disease; PIP= Pneumoniae at immunocompromised patients; TB= Tuberculosis; OSAS=Obstructive sleep apne syndrome; ARDS= “Acute respiratory distress syndrome”; APACHE II= “Acute Physiology and Chronic Health Evaluation”. *Causes of immunsuppresion: Haematological malignancy (4 cases), collagen vascular disease (2 cases), renal transplantation (1 case), renal failure (1 case) Results-1

7. 7 31 patients ( 83.7 % ) Invasive mechanical ventilation Patients with MDR A.baumannii infections; 59.5 % Pneumoniae 100 % of them 24.3 % Results-2

8. 8 Figure 1. Rates of samples that MDR A.baumannii isolated (%) Abbreviations: ETA= Endotracheal aspiration; FOB= Fiberoptic bronchoscopy. Results-3

9. 9 Table 2. Clinical characteristics of patients at the time of the MDR A.baumannii infections Pneumoniae days at ICU*10.3±7.1 Temperature (>37.5 0 C, %) Leukcyte count (/mm 3 )* CRP (mg/dl)* SIRS (%) Sepsis (%) ARDS (%) 48.6 13655±7429 12.3±8.4 64.9 45.9 18.9 Sings at Chest X-ray (%) Lobar infiltrates Bilateral infiltrates Pleural fluid 32.4 43.2 45.9 Organ Failures (%) Respiratory Cardiovasculer Renal 78.4 24.3 18.9 Abbreviations: ICU=İntensive care unit; VAP= ventilator-associated pneumonia; CRP= C-reaktive protein; SIRS= Systemic inflamatory response syndrome; ARDS= “Acute respiratory distress syndrome”. *mean±SD Results-4

10. 10 Table 3. Risk factors at patients with MDR A.baumannii infections Risk factors(%) Re-intubation59.5 Tracheostomy21.6 Fiber Optic Bronchoscopy48.6 Chest Tube13.5 Catheterization27.0 Enteral Feeding56.7 Results-5

11. 11 Figure 2. Antibiotics that used at the time of MDR A.baumannii infections (%) Results-6

12. 12 (%) Figure 3. Rates of antibiotic resistances for A.baumannii that isolated Drug-resistance to all antibiotics was observed in 62.2% of patients Results-7

13. 13 Figure 4. Use of antibiotics for MDR A.baumannii infections (%) Duration of antimicrobial therapy: 13.3± 6.7 days Results-8

14. 14 Table 4. Characteristics, risk factors and prognosis of patients with/without MDR A.baumannii infections MDR A.baumannii (+) 37 patients MDR A.baumannii (-) 181 patients p value Gender (Men), n (%)21 (% 56.8)115 (% 63.5)0.46 Age (yrs)*61.6±19.865.4 ±14.80.27 Re-intubation n, (%)22 (% 59.5)14 (% 7.7)0.001 Tracheostomy n, (%)8 (% 21.6)7 (% 3.9)0.001 Duration of (days)* ICU stay Hospital stay 24.2 ±18.3 33.3 ±19.8 8.21 ±8.3 15.4 ±11.4 <0.0001 Mortality n, (%)18 (% 48.6)71 (% 39.2)0.35 Abbreviatios: MDR= Multidrug resistant; ICU=Intensive care unit. * mean±SD Results-9

15. 15 Discussion (1) Infections with A.baumannii in ICUs Antibiotic resistance VİP due to MDR A.baumannii; antimicrobial therapy

16. 16 Discussion (2) Pneumoniae with MDR A.baumannii - prognosis is similar - durations of ICU and hospital stays are increasing

17. 17 Conclusions In the our respiratory ICU infections with MDR A.baumannii : % 26.6 Drug-resistance to all antibiotics was Observed in 62.2% of patients % 59.5 VİP % 24.3 bacteraemia

18. 18 Teşekkürler…