Antimicrobial treatment and clinical outcome for infections with carbapenem- and multiply-resistant Acinetobacter baumannii around London |
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| Authors: | David M. Livermore Robert L.R. Hill Hazel Thomson André Charlett Jane F. Turton Rachel Pike Bharat C. Patel Rohini Manuel Stephen Gillespie Indran Balakrishnan Stephen P. Barrett Nigel Cumberland Mary Twagira |
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| Affiliation: | 1. Centre for Infections, London, UK;2. North Middlesex University Hospital, London, UK;3. Department of Medical Microbiology, Barts and the London NHS Trust, London, UK;4. Department of Medical Microbiology, Royal Free Hospital, London, UK;5. Department of Medical Microbiology, Charing Cross Hospital, London, UK;6. Department of Medical Microbiology, Frimley Park Hospital, Surrey, UK;7. Department of Medical Microbiology, Mayday University Hospital, London, UK;1. Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland;2. Septic Surgery Unit, Department of Surgery and Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland;3. Charité, University Medicine, Free and Humboldt-University of Berlin, Berlin, Germany;1. Clinical Medicine, University of Sussex, Brighton, UK;2. Medical Microbiology, University of Edinburgh, Edinburgh, UK;3. School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK;4. The Children''s Cancer Hospital, 57357 Cairo, Egypt;2. Division of Postoperative Intensive Care;3. Laboratory of Microbiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti;4. Division of Hygiene, Public Health, and Preventative Medicine, Ancona, Italy;1. Department of R&D Seismology and Acoustics, Royal Netherlands Meteorological Institute (KNMI), Utrechtseweg 297, 3731 GA De Bilt, The Netherlands;2. School of Informatics, Informatics Forum, University of Edinburgh, Edinburgh EH8 9AB, UK;3. British Geological Survey, The Lyell Centre, Research Avenue South, Edinburgh EH14 4AP, UK;1. Science and Technology Option Assessment (STOA), Directorate-General for Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium;2. Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland;3. School of Medicine, University of St Andrews, Scotland, UK;4. International Union Against Tuberculosis and Lung Disease, Centre for Operational Research, Paris, France;5. London School of Hygiene & Tropical Medicine, London, UK;6. Doctors with Africa CUAMM, Padova, Italy;7. World Health Organization, Geneva, Switzerland;8. European and Developing Countries Clinical Trials Partnership (EDCTP), The Hague, Netherlands;9. Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institutet, Sweden;10. Médecins Sans Frontières, Operational Centre Brussels, Belgium;11. Medical Department, Operations Research Unit (LUXOR), Médecins Sans Frontières, Luxembourg, Luxembourg |
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| Abstract: | 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. |
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