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High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia.

Authors
 Doo Ryeon Chung  ;  Jae-Hoon Song  ;  So Hyun Kim  ;  Visanu Thamlikitkul  ;  Shao-Guang Huang  ;  Hui Wang  ;  Thomas Man-kit So  ;  Rohani M. D. Yasin  ;  Po-Ren Hsueh  ;  Celia C. Carlos  ;  Li Yang Hsu  ;  Latre Buntaran  ;  M. K. Lalitha  ;  Min Ja Kim  ;  Jun Yong Choi  ;  Sang Il Kim  ;  Kwan Soo Ko  ;  Cheol-In Kang  ;  Kyong Ran Peck Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201102-0349OC?journalCode=ajrccm 
Citation
 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol.184(12) : 1409-1417, 2011 
Journal Title
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
ISSN
 1073-449X 
Issue Date
2011
MeSH
Acinetobacter ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/pharmacology ; Asia/epidemiology ; Comorbidity ; Cross Infection/drug therapy ; Cross Infection/epidemiology* ; Cross Infection/microbiology ; Cross Infection/mortality ; Drug Resistance, Multiple, Bacterial* ; Female ; Humans ; Klebsiella pneumoniae ; Male ; Middle Aged ; Multivariate Analysis ; Pneumonia, Bacterial/drug therapy ; Pneumonia, Bacterial/epidemiology* ; Pneumonia, Bacterial/microbiology ; Pneumonia, Bacterial/mortality ; Pneumonia, Ventilator-Associated/drug therapy ; Pneumonia, Ventilator-Associated/epidemiology ; Pneumonia, Ventilator-Associated/microbiology ; Pneumonia, Ventilator-Associated/mortality ; Prevalence ; Prospective Studies ; Pseudomonas aeruginosa ; Risk Factors
Keywords
pneumonia ; ventilator-associated ; drug resistance ; microbial ; Acinetobacter ; Pseudomonas aeruginosa ; Klebsiella pneumoniae
Abstract
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.
Full Text
http://www.atsjournals.org/doi/abs/10.1164/rccm.201102-0349OC?journalCode=ajrccm
DOI
10.1164/rccm.201102-0349OC
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94904
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