Multidrug Resistant Acinetobacter baumannii Risk Factors for Appearance of Imipenem Resistant Strains on Patients Formerly with Susceptible Strains 英文参考文献.docVIP

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Multidrug Resistant Acinetobacter baumannii Risk Factors for Appearance of Imipenem Resistant Strains on Patients Formerly with Susceptible Strains 英文参考文献.doc

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Multidrug Resistant Acinetobacter baumannii Risk Factors for Appearance of Imipenem Resistant Strains on Patients Formerly with Susceptible Strains 英文参考文献

MultidrugResistantAcinetobacterbaumannii:Risk FactorsforAppearanceofImipenemResistantStrainson PatientsFormerlywithSusceptibleStrains Jung-JrYe1.,Ching-TaiHuang1.*,Shian-SenShie1,Po-YenHuang1,Lin-HuiSu2,Cheng-HsunChiu3, Hsieh-ShongLeu1,Ping-CherngChiang1 1DivisionofInfectiousDiseases,DepartmentofInternalMedicine,ChangGungMemorialHospital,Taipei,Taoyuan,Taiwan,2DivisionofClinicalPathology,Department ofPathology,ChangGungMemorialHospitalLinkouMedicalCenter,Taipei,Taoyuan,Taiwan,3DivisionofPediatricInfectiousDisease,DepartmentofPediatrics,Chang GungChildren’sHospital,Taipei,Taoyuan,Taiwan Abstract Background: Multidrug resistant Acinetobacter baumannii (MDRAB) is an important nosocomial pathogen usually susceptible to carbapenems; however, growing number of imipenem resistant MDRAB (IR-MDRAB) poses further clinical challenge. The study was designed to identify the risk factors for appearance of IR-MDRAB on patients formerly with imipenemsusceptibleMDRAB(IS-MDRAB)andtheimpactonclinicaloutcomes. Methodology/Principal Findings:A retrospective casecontrolstudy wascarried out for209consecutive episodes ofIS- MDRAB infection or colonization from August 2001 to March 2005. Forty-nine (23.4%) episodes with succeeding clinical isolates of IR-MDRAB were defined as the cases and 160 (76.6%) with all subsequent clinical isolates of IS-MDRAB were defined as the controls. Quantified antimicrobial selective pressure, ‘‘time at risk’’, severity of illness, comorbidity, and demographic data were incorporated for multivariate analysis, which revealed imipenem or meropenem as the only significantindependentriskfactorfortheappearanceofIR-MDRAB(adjustedOR,1.18;95%CI,1.09to1.27).Withselected casesandcontrolsmatchedtoexcludeexogenoussourceofIR-MDRAB,multivariateanalysisstillidentifiedcarbapenemas theonlyindependentriskfactor(adjustedOR,1.48;95%CI,1.14to1.92).Casepatientshadahighercrudemortalityrate comparedtocontrolpatients(57.1%vs.31.3%,p=0.001),andthemortalityofcasepatientswasassociate