VENTILATOR-ASSOCIATED PNEUMONIA DUE TO MULTIDRUGRESISTANT ACINETOBACTER BAUMANNII: INCIDENCE OF RISK FACTORS WITH IMPACT ON EARLY AND LATE MORTALITY

Aušra Čiginskienė, Asta Dambrauskienė, Indrė Zubavičiūtė, Greta Kasputytė, Vidas Pilvinis, Tomas Vanagas, Dalia Adukauskienė

Background. This analysis is aimed to determine the incidence of risk factors for VAP, drug resistance of A.baumannii strains, 7-day (early) and 28-day (late) mortality, and association of risk factors for VAP with early and late mortality in multidrug-resistant (MDR) A.baumannii VAP patients cohort.
Materials and methods. Adult subjects with the first episode of MDR A.baumannii VAP during 2 years period were included. VAP was diagnosed using the 2005 ATS/IDSA criteria. Risk factors for VAP pre­dicting early and late mortality were estimated using binary logistic regression analysis.
Results. The incidence of risk factors for VAP among 60 MDR A.baumannii VAP patients was: both conti­nuous sedation and stress ulcer prophylaxis –100%, exposure to intravenous broad-spectrum antibiotics within the last 90 days – 98.3%, current hospitali­zation ≥ 5 days – 95.0%, red blood cell transfusion – 60.0%, sepsis – 53.3%, mechanical ventilation before VAP >8 days and SAPS II score > 50 on ICU admis­sion – 50.0%. The resistance of A.baumannii strains to both piperacillin/tazobactam and ciprofloxacin was 100%, to carbapenems, cephalosporins 95.0%, to colistin 0%. Early mortality it was estimated to be 28.3%, late one – 55.0%. The SOFA score >12 on ICU admission have predicted early (OR 7.5; 95% CI 2.052-27.408, p=0.002) and late (OR 4.089; 95% Cl 1.292-12.92, p=0.017) mortality, >3 classes of antibiotics used before the onset of VAP (OR 3.993; 95% CI 1.050-15.193, p=0.042) – late one.
Conclusions. It was estimated twice higher late versus early mortality, and marginal resistance of A.baumannii strains to piperacillin/tazobactam, car­bapenems, cephalosporins and ciprofloxacin but co­listin. Both early and late mortality was predicted by higher severity of illness by SOFA score on ICU admission, but only late one – by the treatment with > 3 different classes of antibiotics before VAP onset.