Background: The relationship between multidrug resistance (MDR), inappropriate empiric therapy (IET), and
mortality among patients with Acinetobacter baumannii (AB) remains unclear. We examined it using a large
U.S. database.
Methods: We conducted a retrospective cohort study using the Premier Research database (2009–2013) of 175 U.S.
hospitals. We included all adult patients admitted with pneumonia or sepsis as their principal diagnosis, or as a
secondary diagnosis in the setting of respiratory failure, along with antibiotic administration within 2 days of
admission. Only culture-confirmed infections were included. Resistance to at least three classes of antibiotics
defined multidrug-resistant AB (MDR-AB). We used logistic regression to compute the adjusted relative risk ratio
(RRR) of patients with MDR-AB receiving IET and IET’s impact on mortality.
Results: Among 1423 patients with AB infection, 1171 (82.3 %) had MDR-AB. Those with MDR-AB were older
(63.7 ± 15.4 vs. 61.0 ± 16.9 years, p = 0.014). Although chronic disease burden did not differ between groups, the
MDR-AB group had higher illness severity than those in the non-MDR-AB group (intensive care unit 68.0 % vs. 59.
5 %, p < 0.001; mechanical ventilation 56.2 % vs. 42.1 %, p < 0.001). Patients with MDR-AB were more likely to
receive IET than those in the non-MDR-AB group (76.2 % MDR-AB vs. 13.8 % non-MDR-AB, p < 0.001). In a regression
model, MDR-AB strongly predicted receipt of IET (adjusted RRR 5.5, 95 % CI 4.0–7.7, p < 0.001). IET exposure was
associated with higher hospital mortality (adjusted RRR 1.8, 95 % CI 1.4–2.3, p < 0.001).
Conclusions: In this large U.S. database, the prevalence of MDR-AB among patients with AB infection was > 80 %.
Harboring MDR-AB increased the risk of receiving IET more than fivefold, and IET nearly doubled hospital mortality.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)