High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia.
Doo Ryeon Chung ; Jae-Hoon Song ; Kyong Ran Peck
Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201102-0349OC?journalCode=ajrccm ; Cheol-In Kang ; Kwan Soo Ko ; Sang Il Kim ; Jun Yong Choi ; Min Ja Kim ; M. K. Lalitha ; Latre Buntaran ; Li Yang Hsu ; Celia C. Carlos ; Po-Ren Hsueh ; Rohani M. D. Yasin ; Thomas Man-kit So ; Hui Wang ; Shao-Guang Huang ; Visanu Thamlikitkul ; So Hyun Kim
American Journal of Respiratory and Critical Care Medicine, Vol.184(12) : 1409~1417, 2011
American Journal of Respiratory and Critical Care Medicine
RATIONALE: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality. Increasing antimicrobial resistance has aroused the concern of the failure of antibiotic treatment.
OBJECTIVES: To determine the distribution of the bacterial isolates of HAP and VAP, their antimicrobial resistance patterns, and impact of discordant antibiotic therapy on clinical outcome in Asian countries
METHODS: A prospective surveillance study was conducted in 73 hospitals in 10 Asian countries from 2008-2009. A total of 2,554 cases with HAP or VAP in adults were enrolled and 2,445 bacterial isolates were collected from 1,897 cases. Clinical characteristics and antimicrobial resistance profiles were analyzed.
MEASUREMENT AND MAIN RESULTS: Major bacterial isolates from HAP and VAP cases in Asian countries were Acinetobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. Imipenem resistance rates of Acinetobacter and P. aeruginosa were 67.3% and 27.2%, respectively. Multidrug-resistant rates were 82% and 42.8%, and extensively drug-resistant rates were 51.1% and 4.9%. Multidrug-resistant rate of K. pneumoniae was 44.7%. Oxacillin resistance rate of S. aureus was 82.1%. All-cause mortality rate was 38.9%. Discordant initial empirical antimicrobial therapy increased the likelihood of pneumonia-related mortality (odds ratio, 1.542; 95% confidence interval, 1.127-2.110).
CONCLUSIONS: Acinetobacter spp., P. aeruginosa, S. aureus, and K. pneumoniae are the most frequent isolates from adults with HAP or VAP in Asian countries. These isolates are highly resistant to major antimicrobial agents, which could limit the therapeutic options in the clinical practice. Discordant initial empirical antimicrobial therapy significantly increases the likelihood of pneumonia-related mortality.