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Abstract
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are both associated with significant morbidity and mortality in daily clinical practice, as well as in a critical care setting. It is unclear whether colistin susceptible-only Acinetobacter baumannii (CSO AB) is a unique phenotype separate from or a subset of CRAB-associated pneumonia. The aim of this study is to investigate the prevalence of CSO AB pneumonia and compare the presentation and outcome between CSO AB and CRAB-associated pneumonia in critically ill patients. This multicenter retrospective cohort study initially recruited 955 patients with CR-GNB pneumonia. After exclusion, 575 patients left who were ICU-admitted and had CRAB nosocomial pneumonia remained. Among them, 79 patients had CSO AB pneumonia, classified as the CSO AB group. The other 496 patients were classified as the CRAB group. We compared demographic characteristics, disease severity, and treatment outcomes between the two groups. The prevalence of CSO AB among all cases of CRAB pneumonia was 13.74% (79/575). The CSO AB and CRAB groups had similar demographic characteristics and disease severities at initial presentation. The in-hospital mortality rate was 45.6% and 46.4% for CSO AB and CRAB groups, respectively (p = 0.991). The CSO AB group had significantly better clinical outcomes at day 7 (65.8% vs 52.4%, p = 0.036) but longer length of ICU stay (27 days vs 19 days, p = 0.043) compared to the CRAB group. However, other treatment outcomes, including clinical outcomes at day 14 and 28, mortality, microbiological eradication, ventilator weaning, and newly onset dialysis, were similar. In conclusion, CSO AB accounted for 13.74% of all cases of CRAB pneumonia, and the clinical presentation and treatment outcomes of CSO AB and CRAB pneumonia were similar.
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1 National Defense Medical Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan (GRID:grid.260565.2) (ISNI:0000 0004 0634 0356); National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan (GRID:grid.260565.2) (ISNI:0000 0004 0634 0356)
2 Taipei Veterans General Hospital, Department of Chest Medicine, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314); National Yang Ming Chiao Tung University, Institute of Emergency and Critical Care Medicine, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); National Yang Ming Chiao Tung University, Cancer Progression Research Center, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)
3 Kaohsiung Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696); Kaohsiung Medical University, Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
4 China Medical University Hospital, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taichung, Taiwan (GRID:grid.411508.9) (ISNI:0000 0004 0572 9415); China Medical University, School of Medicine, Taichung, Taiwan (GRID:grid.254145.3) (ISNI:0000 0001 0083 6092)
5 Taichung Veterans General Hospital, Department of Critical Care Medicine, Taichung, Taiwan (GRID:grid.410764.0) (ISNI:0000 0004 0573 0731); National Chung Hsing University, School of Post Baccalaureate Medicine, Taichung, Taiwan (GRID:grid.260542.7) (ISNI:0000 0004 0532 3749)
6 Taipei Veterans General Hospital, Department of Chest Medicine, Taipei, Taiwan (GRID:grid.278247.c) (ISNI:0000 0004 0604 5314); National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017)
7 Kaohsiung Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
8 China Medical University Hospital, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Taichung, Taiwan (GRID:grid.411508.9) (ISNI:0000 0004 0572 9415)
9 Chung Shan Medical University Hospital, Division of Pulmonary Medicine, Department of Internal Medicine, Taichung, Taiwan (GRID:grid.411645.3) (ISNI:0000 0004 0638 9256); Taichung Veterans General Hospital, Division of Chest Medicine, Department of Internal Medicine, Taichung, Taiwan (GRID:grid.410764.0) (ISNI:0000 0004 0573 0731)
10 National Defense Medical Center, School of Public Health, Taipei, Taiwan (GRID:grid.260565.2) (ISNI:0000 0004 0634 0356)
11 National Defense Medical Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan (GRID:grid.260565.2) (ISNI:0000 0004 0634 0356)