중환자의 카바페넴 내성 Acinetobacter baumannii 폐렴 치료 시 발생한 이상사례와 위험 인자
Adverse Events and Their Risk Factors in the Treatment of Carbapenem Resistant Acinetobacter baumannii Pneumonia in the Intensive Care Unit
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Background : Pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has been a major problem for the intensive care unit (ICU) in recent years. However, antibiotics targeting these pathogens frequently cause adverse events. Thus, we investigated the incidence of adverse events, their risk factors, and treatment outcomes in the CRAB pneumonia patient in the ICU. Methods : Electronic medical records of CRAB pneumonia patients admitted to the ICU from January 1, 2015 to April 1, 2017 were reviewed retrospectively. Patients younger than age 18 years or those whose antibiotic maintenance dosage was within two days were excluded from this study. Results : A total of 127 patients were enrolled in this study, 40 of whom experienced an adverse events, and nephrotoxicity was the most common of those events (n=32, 80%). Combined use of nephrotoxic drugs (OR: 3.44, 95% CI: 1.27-9.34, p=0.015) and cancer history (OR: 3.36, 95% CI: 1.14-9.93, p=0.029) were risk factors for adverse events, but inhaled colistin reduced the risk of adverse events (OR: 0.24, 95% CI: 0.09-0.62, p=0.003). The treatment failure rate (OR: 1.62, 95% CI: 1.20-2.19, p=0.004) and in hospital mortality (OR: 2.30, 95% CI: 1.36-3.88, p=0.002) were higher in patients who experienced adverse events than those who did not experience adverse events. Also, patients with nephrotoxic adverse events experienced prolonged admission to the intensive care unit (40.8±28.0 vs 31.6±18.6, p=0.038). Conclusions : Patients with a history of cancer or who received nephrotoxic agents may have increased risk of adverse events when treating CRAB pneumonia. Also, adverse events were associated with negative outcomes, such as treatment failure, increased in hospital mortality, and prolonged ICU hospital stay. Thus, these patients should be closely monitored for occurrence of adverse events, and healthcare providers should consider the safest treatment option for them.
Abstract
Background : Pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has been a major problem for the intensive care unit (ICU) in recent years. However, antibiotics targeting these pathogens frequently cause adverse events. Thus, we investigated the incidence of adverse events, their risk factors, and treatment outcomes in the CRAB pneumonia patient in the ICU. Methods : Electronic medical records of CRAB pneumonia patients admitted to the ICU from January 1, 2015 to April 1, 2017 were reviewed retrospectively. Patients younger than age 18 years or those whose antibiotic maintenance dosage was within two days were excluded from this study. Results : A total of 127 patients were enrolled in this study, 40 of whom experienced an adverse events, and nephrotoxicity was the most common of those events (n=32, 80%). Combined use of nephrotoxic drugs (OR: 3.44, 95% CI: 1.27-9.34, p=0.015) and cancer history (OR: 3.36, 95% CI: 1.14-9.93, p=0.029) were risk factors for adverse events, but inhaled colistin reduced the risk of adverse events (OR: 0.24, 95% CI: 0.09-0.62, p=0.003). The treatment failure rate (OR: 1.62, 95% CI: 1.20-2.19, p=0.004) and in hospital mortality (OR: 2.30, 95% CI: 1.36-3.88, p=0.002) were higher in patients who experienced adverse events than those who did not experience adverse events. Also, patients with nephrotoxic adverse events experienced prolonged admission to the intensive care unit (40.8±28.0 vs 31.6±18.6, p=0.038). Conclusions : Patients with a history of cancer or who received nephrotoxic agents may have increased risk of adverse events when treating CRAB pneumonia. Also, adverse events were associated with negative outcomes, such as treatment failure, increased in hospital mortality, and prolonged ICU hospital stay. Thus, these patients should be closely monitored for occurrence of adverse events, and healthcare providers should consider the safest treatment option for them.
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