Table 1. Patient demographics, VAP incidence, treatment courses, and antimicrobial drug consumption in study of carbapenem-sparing regimen for XDR Acinetobacter baumannii in an ICU, Beirut, Lebanon* .
| Characteristics | Period 1† | Period 2‡ | p value |
|
|---|---|---|---|---|
| Patient data | ||||
| No. patients | 213 | 324 | NA |
|
| Sex | ||||
| F | 79 | 144 | ||
| M | 134 | 180 | ||
| Mean age | 69 | 68 | ||
| Mean length of hospital stay, d | 6.8 | 6 | ||
| Days in ICU |
1,128 |
1,804 |
||
| Type of admission | ||||
| Medical | 163 | 253 | NA | |
| Surgical | 50 | 71 | ||
| Admitted from home or ED | 73 | 114 | ||
| Transferred from ward | 79 | 141 |
|
|
| Transferred from other hospital | 10 | 16 | ||
| Postoperative |
51 |
57 |
||
| Intubation |
|
|||
| At admission | 64 | 85 | ||
| After admission |
14 |
16 |
||
| Outcome | ||||
| A. baumanii VAP incidence, % | 15 | 3.7 | 0.007 | |
| Discharged | 170 | 259 | ||
| Deceased | 43 | 64 | ||
| Total AB VAP events | 32 | 12 | ||
| Deceased during VAP |
17 |
4 |
|
|
| ICU mean mortality rate/month, % | 20.4 | 19.3 | 0.168 | |
| AB VAP case fatality ratio, % |
7.9 |
1.2 |
0.006 |
|
| No. XDR A. baumanii VAP courses received | ||||
| Colistin and carbapenem | 17 | 2 | ||
| Colistin and tigecycline | 6 | 2 | ||
| Colistin monotherapy | 6 | 6 | ||
| Tigecycline |
3 |
2 |
|
|
| Carbapenem consumption, DDD§ | ||||
| Group 1 | 333 | 320 | 0.465 | |
| Group 2 | 455 | 224 | 0.042 | |
| Group 3 | 541 | 223 | <0.005 | |
| Group 4 | 165 | 145 | 0.808 | |
| Group 5 | ||||
| Colistin | 20 | 9 | <0.019 | |
| Tigecycline |
84 |
62 |
0.570 |
|
| Total restricted antimicrobial drugs, DDD | 1,265 | 663 |
<0.005
|
|
*Bold indicates statistical significance. DDD, defined daily doses; ED, emergency department, ESBL, extended-spectrum β-lactamase; ICU, intensive care unit; NA, not applicable; VAP, ventilator-associated pneumonia; XDR, extensively drug-resistant. †During February 1, 2016–June 30, 2016, ICU patients received colistin/carbapenem therapy for A. baumannii infections. ‡During July 1, 2016–January 31, 2017, ICU implemented carbapenem-sparing regimen for A. baumannii infections. §Group 1, antimicrobial drugs that do not require infectious disease specialist preapproval, such as third-generation cephalosporins, amoxicillin/clavulanic acid, and quinolones; group 2, oral vancomycin and metronidazole used for Clostridioides difficile therapy; group 3, imipenem and meropenem; group 4, broad-spectrum carbapenem-sparing regimens, including piperacillin/tazobactam, cefepime, ceftazidime, amikacin; and group 5, the XDR A. baumanii–active antimicrobial drugs colistin and tigecycline.