Department of Emergency Medicine, Taipei Veterans General Hospital, No.201, Section 2, Shipai Road, Taipei, 11217, Taiwan.
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Antimicrob Resist Infect Control. 2020 Sep 29;9(1):160. doi: 10.1186/s13756-020-00824-4.
The impact of appropriate antimicrobial therapy for A. baumannii bacteremic pneumonia has not been well established due to the inclusion of the three phenotypically indistinguishable Acinetobacter species and confounding factors including underlying diseases and severity of infection. This retrospective study aimed to evaluate the impact of appropriate antimicrobial therapy on 14-day mortality in A. baumannii bacteremic pneumonia patients after adjusting for risk factors.
This study was conducted at five medical centers in Taiwan between July 2012 and June 2016. A. baumannii species identification was performed using reference molecular methods. Risk factors for 14-day mortality were analyzed via logistic regression. The interaction between the Acute Physiology and Chronic Health Evaluation (APACHE) II score and appropriate antimicrobial therapy was assessed using the logistic model.
A total of 336 patients with monomicrobial A. baumannii bacteremic pneumonia were included in this study. The overall 14-day mortality rate was 47.3%. The crude mortality of appropriate antimicrobial therapy was 35.9% (57 of 151 patients). Appropriate antimicrobial therapy was associated with a lower mortality after multivariate adjustment (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.34-0.97; p = 0.04), and the effect was influenced by APACHE II score (OR for interaction term, 0.0098; 95% CI, 0.0005-0.1885; p = 0.002). Further analysis demonstrated that appropriate antimicrobial therapy significantly reduced 14-day mortality among the patients with an APACHE II score > 35 (OR 0.0098; 95% CI 0.0005-0.1885).
Appropriate antimicrobial therapy decreases 14-day mortality of the most severely ill patients with A. baumannii bacteremic pneumonia.
由于三种表型上无法区分的鲍曼不动杆菌种和混杂因素（包括基础疾病和感染严重程度）的存在，适当的抗菌治疗对鲍曼不动杆菌菌血症性肺炎患者 14 天死亡率的影响尚未得到充分证实。本回顾性研究旨在调整危险因素后评估适当抗菌治疗对鲍曼不动杆菌菌血症性肺炎患者 14 天死亡率的影响。
本研究于 2012 年 7 月至 2016 年 6 月在台湾的五家医疗中心进行。使用参考分子方法进行鲍曼不动杆菌种鉴定。通过逻辑回归分析 14 天死亡率的危险因素。使用逻辑模型评估急性生理学和慢性健康评估（APACHE）II 评分与适当抗菌治疗之间的相互作用。
共纳入 336 例单一致病菌血症性鲍曼不动杆菌肺炎患者。总的 14 天死亡率为 47.3%。适当抗菌治疗的粗死亡率为 35.9%（57/151 例）。多变量调整后，适当的抗菌治疗与较低的死亡率相关（比值比 [OR]，0.57；95%置信区间 [CI]，0.34-0.97；p=0.04），并且该效果受 APACHE II 评分的影响（交互项的 OR，0.0098；95%CI，0.0005-0.1885；p=0.002）。进一步分析表明，适当的抗菌治疗可显著降低 APACHE II 评分>35 的患者 14 天死亡率（OR 0.0098；95%CI 0.0005-0.1885）。
适当的抗菌治疗可降低病情最严重的鲍曼不动杆菌菌血症性肺炎患者的 14 天死亡率。
