JAC Advance Access originally published online on January 9, 2007
Journal of Antimicrobial Chemotherapy 2007 59(3):525-530; doi:10.1093/jac/dkl499
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Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia
1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-ku, Seoul 135-710, Korea 2 Asian-Pacific Research Foundation for Infectious Diseases (ARFID), 50 Irwon-dong, Kangnam-ku, Seoul, Korea 3 Division of Infectious Diseases, Kyungpook National University Hospital, 50 Samduk-2ga, Jung-gu, Daegu, Korea 4 Division of Infectious Diseases, Chonnam National University Hospital, 8 Hak-dong, Dong-gu, Gwangju, Korea 5 Department of Infectious Diseases, Keimyung University Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu, Korea 6 Division of Infectious Diseases, Cheju National University Hospital, Cheju National University, 154 Samdo-2 dong, Jeju City, Cheju, Korea 7 Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-ku, Seoul, Korea
Received 26 June 2006; returned 2 August 2006; revised 1 November 2006; accepted 9 November 2006
* Corresponding author. Tel: +82-2-3410-0320; Fax: +82-2-3410-0328; E-mail: jhsong{at}smc.samsung.co.kr or jhsong{at}ansorp.org
Objectives: To investigate the impact of imipenem resistance on the mortality rate among patients with Acinetobacter bacteraemia.
Methods: A retrospective, pairwise-matched (1:1), risk-adjusted (age, Pitt bacteraemia score) cohort study was performed at three tertiary care hospitals in Korea from January 2000 to June 2005.
Results: Forty patients with imipenem non-susceptible Acinetobacter bacteraemia (INAB group) and 40 matched subjects (1:1 ratio) with imipenem-susceptible Acinetobacter bacteraemia (ISAB group) were included. Both groups had similar clinical features related to the severity of illness. The 30 day mortality rate was higher in the INAB group (57.5%) than the ISAB group (27.5%) (P = 0.007). The rate of discordant antimicrobial therapy was higher in the INAB group (65.0%) than the ISAB group (20.0%) (P < 0.001). The 30 day mortality rate was higher in the patients with discordant antimicrobial therapy (67.6%) than concordant antimicrobial therapy (23.9%) (P < 0.001). Multivariate analysis showed that age, the Pitt bacteraemia score, immunosuppressive status, and discordant antimicrobial therapy were independent risk factors for 30 day mortality among patients with Acinetobacter bacteraemia (P < 0.05). When discordant antimicrobial therapy was excluded in the multivariate analysis, the imipenem resistance was associated with 30 day mortality (P = 0.005).
Conclusions: Imipenem resistance has a significant impact on the mortality rate among patients with Acinetobacter bacteraemia, and this is mainly attributable to the higher rate of discordant antimicrobial therapy.
Keywords: matched cohort study , attributable mortality , discordant antimicrobial therapy
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