Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-09T11:58:37.112Z Has data issue: false hasContentIssue false
  • English
  • Français

National Survey of Thai Infectious Disease Physicians on Treatment of Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia: The Role of Infection Control Awareness

Published online by Cambridge University Press:  29 October 2015

Aubonphan Buppajarntham ,
Anucha Apisarnthanarak ,
Thana Khawcharoenporn ,
Sasinuch Rutjanawech  and
Nalini Singh
Aubonphan Buppajarntham
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Anucha Apisarnthanarak*
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Thana Khawcharoenporn
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Sasinuch Rutjanawech
Affiliation:
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Nalini Singh
Affiliation:
Division of Infectious Diseases, Children’s National Medical Center, Department of Pediatrics, Epidemiology and Global Health, George Washington University, School of Medicine and Health Sciences, School of Public Health, Washington DC, United States
*
Address correspondence to Anucha Apisarnthanarak, MD, Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand, 10120 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP)

METHODS

From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (<60%), standard (60%–80%), and high (>80%) categories and were then compared with standard clinical response rates archived in the existing literature.

RESULTS

Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17–7.73; P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16–15.37; P<.01) and having higher number of ID consultation cases per month (aOR, 4.84; 95% CI, 1.98–11.80; P<.01) were associated with standard and high clinical success rates (>60%). We identified a significant correlation between expected and clinical success rates (r=0.58; P<.001).

CONCLUSIONS

Awareness of IC among IDPs can improve physicians’ expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success.

Infect. Control Hosp. Epidemiol. 2015;37(1):61–69

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 1 , January 2016 , pp. 61 - 69
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Higgins, PG, Dammhayn, C, Hackel, M, Seifert, H. Global spread of carbapenem-resistant Acinetobacter baumannii . J Antimicrob Chemother 2010;65:233–238.Google Scholar
2. Mugnier, PD, Poirel, L, Naas, T, Nordmann, P. Worldwide dissemination of the blaOXA-23 carbapenemase gene of Acinetobacter baumannii . Emerg Infect Dis 2010;16:35–40.Google Scholar
3. Young, LS, Sabel, AL, Price, CS. Epidemiologic, clinical, and economic evaluation of an outbreak of clonal multidrug-resistant Acinetobacter baumannii infection in a surgical intensive care unit. Infect Control Hosp Epidemiol 2007;28:1247–1254.Google Scholar
4. Betrosian, AP, Frantzeskaki, F, Xanthaki, A, Douzinas, EE. Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia. J Infect 2008;56:432–436.Google Scholar
5. Chan, JD, Graves, JA, Dellit, TH. Antimicrobial treatment and clinical outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia. J Intensive Care Med 2010;25:343–348.Google Scholar
6. Gurjar, M, Saigal, S, Baronia, AK, et al. Carbapenem-resistant Acinetobacter ventilator-associated pneumonia: clinical characteristics and outcome. Indian J Crit Care Med 2013;17:129–134.Google Scholar
7. Chang, HC, Chen, YC, Lin, MC, et al. Mortality risk factors in patients with Acinetobacter baumannii ventilator: associated pneumonia. J Formos Med Assoc 2011;110:564–571.Google Scholar
8. Vahdani, P, Yaghoubi, T, Aminzadeh, Z. Hospital acquired antibiotic-resistant Acinetobacter baumannii infections in a 400-bed hospital in Tehran, Iran. Int J Prev Med 2011;2:127–130.Google Scholar
9. Gaynes, R, Edwards, JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by Gram-negative bacilli. Clin Infect Dis 2005;41:848–854.Google Scholar
10. Kanafani, ZA, Kara, L, Hayek, S, Kanj, SS. Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms. Infect Control Hosp Epidemiol 2003;24:864–869.Google Scholar
11. Paul, M, Weinberger, M, Siegman-Igra, Y, et al. Acinetobacter baumannii: emergence and spread in Israeli hospitals, 1997–2002. J Hosp Infect 2005;60:256–260.Google Scholar
12. Danchaivijitr, S, Judaeng, T, Sripalakij, S, Naksawas, K, Plipat, T. Prevalence of nosocomial infection in Thailand, 2006. J Med Assoc Thai 2007;90:1524–1529.Google ScholarPubMed
13. Chawla, R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries. Am J Infect Control 2008;36:S93–S100.Google Scholar
14. Werarak, P, Kiratisin, P, Thamlikitkul, V. Hospital-acquired pneumonia and ventilator-associated pneumonia in adults at Siriraj Hospital: etiology, clinical outcomes, and impact of antimicrobial resistance. J Med Assoc Thai 2010;93:S126–S138.Google Scholar
15. NARST: National Antimicrobial Resistance Surveillance Center, Thailand, Web site. http://narst.dmsc.moph.go.th/. Published 2014. Accessed Febuary 2, 2015.Google Scholar
16. Bassetti, M, Righi, E, Esposito, S, Petrosillo, N, Nicolini, L. Drug treatment for multidrug-resistant Acinetobacter baumannii infections. Future Microbiol 2008;3:649–660.Google Scholar
17. Tripodi, MF, Durante-Mangoni, E, Fortunato, R, Utili, R, Zarrilli, R. Comparative activities of colistin, rifampicin, imipenem and sulbactam/ampicillin alone or in combination against epidemic multidrug-resistant Acinetobacter baumannii isolates producing OXA-58 carbapenemases. Int J Antimicrob Agents 2007;30:537–540.Google Scholar
18. Rodriguez, CH, De Ambrosio, A, Bajuk, M, et al. In vitro antimicrobial activity against endemic Acinetobacter baumannii multiresistant clones. J Infect Dev Ctries 2010;4:164–167.Google Scholar
19. Tan, TY, Lim, TP, Lee, WH, Sasikala, S, Hsu, LY, Kwa, AL. In vitro antibiotic synergy in extensively drug-resistant Acinetobacter baumannii: the effect of testing by time-kill, checkerboard, and Etest methods. Antimicrob Agents Chemother 2011;55:436–438.Google Scholar
20. Falagas, ME, Kasiakou, SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis 2005;40:1333–1341.Google Scholar
21. Lu, Q, Girardi, C, Zhang, M, et al. Nebulized and intravenous colistin in experimental pneumonia caused by Pseudomonas aeruginosa . Intensive Care Med 2010;36:1147–1155.Google Scholar
22. Imberti, R, Cusato, M, Villani, P, et al. Steady-state pharmacokinetics and BAL concentration of colistin in critically Ill patients after IV colistin methanesulfonate administration. Chest 2010;138:1333–1339.Google Scholar
23. Kalin, G, Alp, E, Akin, A, Coskun, R, Doganay, M. Comparison of colistin and colistin/sulbactam for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia. Infection 2014;42:37–42.Google Scholar
24. Management of multidrug-resistant organism in healthcare settings. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/hicpac/mdro/mdro_0.html. Published 2006. Accessed Febuary 2, 2015.Google Scholar
25. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.Google Scholar
26. Kaye, KS, Harris, AD, McDonald, JR, Strausbaugh, LJ, Perencevich, E, Infectious Diseases Society of America Emerging Infections N. Measuring acceptable treatment failure rates for community-acquired pneumonia: potential for reducing duration of treatment and antimicrobial resistance. Infect Control Hospi Epidemiol 2008;29:137–142.Google Scholar
27. Perencevich, EN, Harris, AD, Kaye, KS, et al. Physicians acceptable treatment failure rates in antibiotic therapy for coagulase-negative staphylococcal catheter-associated bacteremia: implications for reducing treatment duration. Clin Infect Dis 2005;41:1734–1741.CrossRefGoogle ScholarPubMed
28. Perencevich, EN, Kaye, KS, Strausbaugh, LJ, Fisman, DN, Harris, AD, Infectious Diseases Society of America Emerging Infections N. Acceptable rates of treatment failure in osteomyelitis involving the diabetic foot: a survey of infectious diseases consultants. Clin Infect Dis 2004;38:476–482.Google Scholar
29. Lister, PD, Wolter, DJ. Levofloxacin-imipenem combination prevents the emergence of resistance among clinical isolates of Pseudomonas aeruginosa . Clin Infect Dis 2005;40:S105–S114.Google Scholar
30. Gribble, MJ, Chow, AW, Naiman, SC, et al. Prospective randomized trial of piperacillin monotherapy versus carboxypenicillin-aminoglycoside combination regimens in the empirical treatment of serious bacterial infections. Antimicrob Agents Chemother 1983;24:388–393.Google Scholar
31. Fish, DN, Piscitelli, SC, Danziger, LH. Development of resistance during antimicrobial therapy: a review of antibiotic classes and patient characteristics in 173 studies. Pharmacotherapy 1995;15:279–291.Google Scholar
32. Hilf, M, Yu, VL, Sharp, J, Zuravleff, JJ, Korvick, JA, Muder, RR. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am J Med 1989;87:540–546.Google Scholar
33. Hirsch, EB, Tam, VH. Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother 2010;65:1119–1125.Google Scholar
34. Bodey, GP, Jadeja, L, Elting, L. Pseudomonas bacteremia. Retrospective analysis of 410 episodes. Arch Intern Med 1985;145:1621–1629.Google Scholar
35. Daikos, GL, Tsaousi, S, Tzouvelekis, LS, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 2014;58:2322–2328.CrossRefGoogle ScholarPubMed
36. Raineri, E, Pan, A, Mondello, P, Acquarlo, A, Candiani, A, Crema, L. Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit. Am J Infect Control 2008;36:283–290.Google Scholar
37. Jenkins, TC, Price, CS, Sabel, AL, Mehler, PS, Burman, WJ. Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of Staphylococcus aureus bacteremia. Clin Infect Dis 2008;46:1000–1008.Google Scholar
38. Rieg, S, Peyerl-Hoffmann, G, de With, K, et al. Mortality of S. aureus bacteremia and infectious diseases specialist consultation—a study of 521 patients in Germany. J Infect 2009;59:232–239.Google Scholar
39. Doern, GV, Vautour, R, Gaudet, M, Levy, B. Clinical impact of rapid in vitro susceptibility testing and bacterial identification. J Clin Microbiol 1994;32:1757–1762.Google Scholar
40. Elhanan, G, Sarhat, M, Raz, R. Empiric antibiotic treatment and the misuse of culture results and antibiotic sensitivities in patients with community-acquired bacteraemia due to urinary tract infection. J Infect 1997;35:283–288.Google Scholar
41. Gomez, J, Conde Cavero, SJ, Hernandez Cardona, JL, et al. The influence of the opinion of an infectious disease consultant on the appropriateness of antibiotic treatment in a general hospital. J Antimicrob Chemother 1996;38:309–314.Google Scholar
42. Byl, B, Clevenbergh, P, Jacobs, F, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 1999;29:60–66.CrossRefGoogle ScholarPubMed
43. Apisarnthanarak, A, Danchaivijitr, S, Bailey, TC, Fraser, VJ. Inappropriate antibiotic use in a tertiary care center in Thailand: an incidence study and review of experience in Thailand. Infect Control Hosp Epidemiol 2006;27:416–420.Google Scholar
44. Apisarnthanarak, A, Bhooanusas, N, Yaprasert, A, Mundy, LM. Carbapenem de-escalation therapy in a resource-limited setting. Infect Control Hosp Epidemiol 2013;34:1310–1313.Google Scholar
45. Apisarnthanarak, A, Khawcharoenporn, T, Mundy, LM. Practices to prevent multidrug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus in Thailand: a national survey. Am J Infect Control 2013;41:416–421.Google Scholar
46. Petrak, RM, Sexton, DJ, Butera, ML, et al. The value of an infectious diseases specialist. Clin Infect Dis 2003;36:1013–1017.Google Scholar
Supplementary material: File

Buppajarntham supplementary material

Appendix

Download Buppajarntham supplementary material(File)
File 42 KB