Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

  • Shaher Samrah Jordan University of Science and Technology, Irbid, Jordan
  • Yazan Bashtawi Jordan University of Science and Technology, Irbid, Jordan
  • Wail Hayajneh Jordan University of Science and Technology, Irbid, Jordan
  • Basima Almomani Jordan University of Science and Technology, Irbid, Jordan
  • Suleiman Momany Jordan University of Science and Technology, Irbid, Jordan
  • Yousef Khader Jordan University of Science and Technology, Irbid, Jordan
Keywords: Acinetobacter, colistin, ventilator-associated pneumonia, multidrug resistant

Abstract

Introduction: There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistin-only-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB.

Methodology: Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality.

Results: A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days.

Conclusions: A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.

Author Biographies

Shaher Samrah, Jordan University of Science and Technology, Irbid, Jordan

Assistant Professor.

Pulmonary and Critical Care Medicine, Department of Internal Medicine

Yazan Bashtawi, Jordan University of Science and Technology, Irbid, Jordan
Department of Internal Medicine
Wail Hayajneh, Jordan University of Science and Technology, Irbid, Jordan

Associate professor.

Pediatric Infectious diseases, Department of Pediatrics

Basima Almomani, Jordan University of Science and Technology, Irbid, Jordan
Department of Clinical Pharmacy
Suleiman Momany, Jordan University of Science and Technology, Irbid, Jordan

Assistant Professor.

Pulmonary and Critical Care Medicine, Department of Internal Medicine

Yousef Khader, Jordan University of Science and Technology, Irbid, Jordan

Professor.

Department of Public Health and Family Medicine

Published
2016-10-31
How to Cite
1.
Samrah S, Bashtawi Y, Hayajneh W, Almomani B, Momany S, Khader Y (2016) Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii. J Infect Dev Ctries 10:1129-1134. doi: 10.3855/jidc.7203
Section
Brief Original Articles