VIÊM PHỔI LIÊN QUAN THỞ MÁY DO ACINETOBACTER BAUMANNII TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Objectives: To describe characteristics of epidemiological and clinical of ventilator associated pneumonia due to Acinetobacter baumannii and susceptibility of antibiotic. Subjects and methods: A retrospective case series of 34 ventilator associated pneumonia patients with A. baumannii positive quantitative culture of tracheal aspirate in pediatric hospital 1 from January 2020 to December 2021. Results: The median age was 14,4 months. 55,9% of cases were over 12 months. Half of cases were transferred from another hospital. All patients had risk factors for ventilator associated pneumonia; enteral feeding in 34/34 (100%) patients; using proton pump inhibitor 22/34 (64,7%); reintubation 18/34 (52,9%). Common underlying illness was neuromuscular disease and congenital heart disease. Common clinical symptom was fever 79,4%. Elevated C-reactive protein >20 mg/dl was 24/34 (70,6%) cases. PCT > 2 ng/ml in 50% cases (6/12), median PCT was 1,5 ng/ml. The median time before starting ventilator associated pneumonia was 6 days. The predominant lesion on chest X-rays was broncho-pneumonia (73,5%) and lobar-pneumonia was 26,5%. The rate of co-infection was 32,3%. Stenotrophomonas maltophilia (n=6, 54,5%), Klebsiella pneumoniae (n=2, 18,2%); Pseudomonas aeruginosa (n=1), Staphylococcus aureus(n=1) and Elizabethkingia meningoseptica (n=1). The rate of antibiotic resistance of A.baumannii was: imipenem 88,2%, meropenem 91,2% and levofloxacin 85,3%; ciprofloxacin 97,1%; amikacin 14,7%; ampicillin/sulbactam 85,3%. The mortality rate was 26,5%. Conclusions: Ventilator associated pneumonia due to A.baumannii has high mortality rate. A.baumannii are highly resistant to available antimicrobials. Therefore, more research on antibiotic therapy for children infected with A. baumannii is necessary.