Abstract 230 - IMPIEGO DEI GLICOPEPTIDI NELLA ... - SIMIT

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10° CONGRESSO NAZIONALE SIMIT
Abstract 285
- DESCRIPTION OF AN OUTBREAK OF MULTIRESISTANT ACINETOBACTER
BAUMANNII (MDR): CLINICAL IMPACT, GENOTYPIC ANALYSIS AND OUTCOME -
Migliorino G. M.* [1] , Motta E. [1] , Bramati S. [1] , Foti G. [1] , Rossi M. [1] , Viganò F. [1] , Gori A. [1]
- [1] Azienda Ospedaliera San Gerardo ~ Monza
ANTIBIOTICO RESISTENZA
Premessa: Acinetobacter b. causes nosocomial outbreaks, especially in critically ill
patients. Attributable mortality due to A.b is 8-23%; in ICU is estimated to be among 10-
43%. There are no guidelines to suggest what is the standard of care and how best to treat
A. infection. In the study were considered all patients referred to the HSG of Monza with at
least one positive isolation for A.b.-MDR clonally related during the period 2009-2010. The
total number of patients analyzed is 37
Obiettivo: Analysis of an outbreak of A.b:
Genotypic characterization of isolates
Efficacy of measures to contain the epidemic
Choice of treatments and outcome
Risultati: Overall 29/37 of patients developed infection while 8/37 colonization. Out of a
total of 29 clinically manifest infections 17/29 had lung as the primary location. Multiple
locations occurred in 5 cases. Admission to ICU was the most significant factor in relation
to lung infections as the use of antibiotics during hospitalization before the isolation
especially as regards the use of carbapenems.
Pulmonary infections were treated in 14/17 cases by iv Colistin 2-3 MUx3 + Amp/Sulb iv
4g x 4+Colistin 1 MUx3 delivered by endobronchial aerosol. In 2/17 cases Tigecycline was
added. The crude mortality for all patients was 43.2% and 55.1% when considering only
acute infections. In 12/16 cases was attributed not to be A.b. related while in 4/16 A.b. was
considered a possible contributing cause of death
Conclusione: Genotypic typing confirmed the ability of A.b MDR to spread rapidly in
intensivist area. The choice of both systemic and endobronchial therapy of Colistin
combined with Amp/Sulb HD was highly effective.The low intrinsic pathogenicity of A.b
allows not treating colonizations. Mortality attributable to infections observed in our series
was 13.7% in the low range reported in literature (10-43%) in ICU of which our population
represents the vast majority (72,9%). Despite the preventive procedures adopted, active or
passive, spread of A.b is difficult to control