Analysis of <i>Acinetobacter baumannii</i> resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy

• Main Authors: Aneta Grochowalska, Maria Kozioł-Montewka, Anna Sobieszczańska
• Format: Article
• Language: English
• Published: Institute of Rural Health 2017-06-01
• Series: Annals of Agricultural and Environmental Medicine
• Subjects: COPD; antibiotics; Acinetobacter baumannii; multidrug-resistant strains; co-infection
• Online Access: http://www.journalssystem.com/aaem/Analysis-of-Acinetobacter-baumannii-resistance-patterns-in-patients-with-chronic-obstructive-pulmonary-disease-COPD-in-terms-of-choice-of-neffective-empiric-antibiotic-therapy,74710,0,2.html
• ISSN: 1232-1966; 1898-2263

Introduction Multi-resistant <i>Acinetobacter baumannii</i> isolated from patients has become one of the most hazardous pathogens in health care settings. The aim of the study was to analyze pneumonia caused by <i>Acinetobacter baumannii</i> in patients hospitalized because of exacerbation of chronic obstructive pulmonary diseases (COPD), who were admitted to the Pulmonology Ward of the Masovian Specialistic Hospital in Radom (MSS). The incidence and drug sensitivity of these non-fermenting rods were evaluated, and compliance with antimicrobial procedure with the algorithm of the guidelines in applicable recommendations, was estimated. This should result in determining the local patterns of resistance and verifying therapeutic procedures in accordance with the assumptions of hospital antibiotic policy. In addition, the study examined the effectiveness of empiric and targeted therapy according to the clinical condition of the patient, and the eradication of A. baumannii, in comparison with the aggravating factors of the patient. Material and Methods The retrospective study included 90 patients with exacerbation of COPD whose etiological factor of infection was <i>A. baumannii</i>, hospitalized in the Department of Pulmonology (MSS) in 2012–2016. Results Studies were conducted on 90 patients with COPD exacerbation from which <i>A. baumannii</i> was isolated. Co-infections with other bacterial species among 41 patients were additionally noted. The majority of <i>A. baumannii</i> strains showed a high resistance (90%) to fluoroquinolones, ceftazidime, piperacillin/tazobactam. For strains causing a co-infection, drug resistance was successively 44–56%, 44%, 44%. All of patients received empirical therapy. The most commonly used drug was 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 was performed which proved to be effective in 58% of treated cases by susceptibility testing. The highest efficacy was observer after the use of colistin and carbapenems. Conclusions In the performed study, the infections caused by multi-resistant <i>Acinetobacter baumannii</i>, were observed in COPD, which should be taken into consideration in choosing empirical antibiotic therapy. Simultaneously, the local resistance patterns 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 this study, the mortality percent exceeded 29%.