Multidrug resistant acinetobacter baumannii in ventilator associated pneumonia: Prevalence and predictors of mortality

Background: Acinetobacter baumannii (A. baumannii) is one of the most challenging pathogens in Ventilator-associated pneumonia (VAP) patients as the treatments are limited to only a few antibiotics. Worldwide, the emergence of multidrug resistant A. baumannii (MDR-AB) strains has become increasingly common in hospitals and associated with significant impact on patient's survival and hospital cost. Aims and objectives: To determine the prevalence and predictors of mortality for MDR-AB in patients with VAP. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital, to collect data from patients with MDR-AB VAP from 1st January 2007 to 31st June 2013. After having obtained ethical approval, the list of candidate patients were retrieved using computerized database in the hospital. Results: Of the 121 patients diagnosed with A. baumannii VAP, 98.3% (119/121) were infected with MDR-AB, and thus were included in the final detailed analysis. Multivariate analysis adjusted for possible confounders (age and gender variables) revealed that only lower number of definitive therapy (OR=0.451, 95% CI: 0.281?0.726, p=0.001) was an independent predictors of 14-days mortality in MDR-AB VAP patients. In addition, using ipratropium bromide/ albuterol sulfate during mechanical ventilation (OR=0.152, 95% CI: 0.031?0.733, p=0.019) was identified as an independent factor associated with low mortality. Conclusions: Identification of prognostic factors of mortality would be a reliable tool for early detection and guiding empirical therapy.