标题：Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy
期刊名称：Annals of Agricultural and Environmental Medicine
印刷版ISSN：1232-1966
电子版ISSN：1898-2263
出版年度：2017
卷号：24
期号：2
页码：307-311
DOI：10.26444/aaem/74710
出版社：Institute of Agricultural Medicine in Lublin
摘要：Introduction. Multi-resistant Acinetobacter baumannii isolated from patients has become one of the most hazardouspathogens in health care settings. The aim of the study was to analyze pneumonia caused by Acinetobacter baumannii inpatients hospitalized because of exacerbation of chronic obstructive pulmonary diseases (COPD), who were admitted tothe Pulmonology Ward of the Masovian Specialistic Hospital in Radom (MSS). The incidence and drug sensitivity of thesenon-fermenting rods were evaluated, and compliance with antimicrobial procedure with the algorithm of the guidelines inapplicable recommendations, was estimated. This should result in determining the local patterns of resistance and verifyingtherapeutic procedures in accordance with the assumptions of hospital antibiotic policy. In addition, the study examinedthe effectiveness of empiric and targeted therapy according to the clinical condition of the patient, and the eradication ofA. baumannii, in comparison with the aggravating factors of the patient.Materials and Method. The retrospective study included 90 patients with exacerbation of COPD whose etiological factorof infection was A. baumannii, hospitalized in the Department of Pulmonology (MSS) in 2012–2016.Results. Studies were conducted on 90 patients with COPD exacerbation from which A. baumannii was isolated. Co-infectionswith other bacterial species among 41 patients were additionally noted. The majority of A. baumannii strains showed ahigh resistance (90%) to fluoroquinolones, ceftazidime, piperacillin/tazobactam. For strains causing a co-infection, drugresistance was successively 44–56%, 44%, 44%. All of patients received empirical therapy. The most commonly used drugwas amoxicillin with a clavulanic acid, often combined with fluoroquinolone. This type of therapy was effective among 10%of patients. The mortality in this group was determined at 29%. Among 79% of patients with COPD, a targeted therapy wasperformed which proved to be effective in 58% of treated cases by susceptibility testing. The highest efficacy was observerafter the use of colistin and carbapenems.Conclusion. In the performed study, the infections caused by multi-resistant Acinetobacter baumannii, were observed inCOPD, which should be taken into consideration in choosing empirical antibiotic therapy. Simultaneously, the local resistancepatterns of multi-drug-resistant (MDR) Gram-negative strains co-infecting COPD should be considered in empirical treatment.Moreover, both additional clinical complication and co-infections contribute to a more severe course of diseases. In thisstudy, the mortality percent exceeded 29%.
