The Role of APACHE-II Score in Predicting Acinetobacter baumannii Colonization/Infection and Its Antimicrobial Resistance Pattern in Indonesian Teaching Hospital

Ian Huang¹, Gregoey Joey¹, Cucunawangsih^2, and Oloan E. Tampubolon³

¹Faculty of Medicine, University of Pelita Harapan, Tangerang, Indonesia

²Department of Microbiology, Faculty of Medicine, University of Pelita Harapan, Tangerang, Indonesia

³Intensive Care Unit, Siloam Hospital Lippo Village, Tangerang, Indonesia

Cite this paper:
Ian Huang, Gregoey Joey, Cucunawangsih and Oloan E. Tampubolon. The Role of APACHE-II Score in Predicting Acinetobacter baumannii Colonization/Infection and Its Antimicrobial Resistance Pattern in Indonesian Teaching Hospital. American Journal of Infectious Diseases and Microbiology. 2016; 4(3):56-60. doi: 10.12691/ajidm-4-3-2

Abstract

Background: A first precautionary action against Acinetobacter baumannii (A.baumanii) can be conducted by identifying well-established risk factors of colonization/infection of that pathogen, such as underlying severity of illness. There are hardly any studies regarding the role of APACHE-II score in predicting risk of A.baumannii colonization/infection in Indonesia. Materials and Methods: A retrospective, case control investigation was performed with medical and microbiology records of ICU patients in an Indonesian Teaching Hospital from January 2013 to December 2014. Results: There were 39 patients with A.baumannii colonization/infection and 59 patients with non-A.baumannii colonization/infection enrolled in this study. Patients with A.baumannii colonization/infection had a significantly higher APACHE II score than non-Acinetobacter group, 25.7 and 23.1 (p=0.038), respectively. APACHE II score ≥ 23 had 74.4% sensitivity and 50.8 specificity to A.baumannii colonization/infection [odd ratio (OR) 3.00, 95% confidence interval (CI) 1.24-7.24, p=0.013], on the other hand APACHE II ≥ 27 had a 53.8% sensitivity and 78.0% specificity (OR 3.75, 95% CI 1.57-8.95, p=0.002). The highest susceptibility level of antibiotics against A.baumannii in this study was shown by tigecycline (82.1%) and amikacin (84.6%). Conclusions: APACHE-II score was strongly correlated with A.baumannii colonization/infection and a cut-off value of APACHE II score ≥ 23 may be used to depict increased moderate risk of A.baumannii colonization/infection. While the use carbapenem against A. baumannii infection was not recommended, tigecycline and amikacin may be considered as antibiotics of choice in treating A.baumannii infection in our hospital setting.

Keywords:
A.baumanii APACHE-II score colonization risk factors

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Fishbain, J., and A.Y. Peleg, 2010. Treatment of acinetobacter infections. Clin Infect Dis., 51 (1): 79-84.
[2]	Peleg, A.Y., H. Seifert, and D.L. Paterson, 2008. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev., 21: 538-582.
[3]	Maragakis, L.L., and T.M. Perl, 2008. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis., 46:1254-1263.
[4]	Naved, S.A., S. Siddiqui, and F.H. Khan, 2011. APACHE-II Score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak., 21 (1): 4-8.
[5]	Clinical and Laboratory Standard Institute, 2014. M100-S24 Performance standards for antimicrobial susceptibility testing; Twenty-fourth informational supplement. http://ncipd.org/control/images/NCIPD_docs/CLSI_M100-S24.pdf (Accessed on October 16, 2015).
[6]	Manchanda, V., S. Sanchaita, and N.P. Singh, 2010. Multidrug resistant acinetobacter. J Glob Infect Dis., 2(3): 291-304.
[7]	Sunenshine, R.H., M.-O. Wright, L.L. Maragakis, A.D. Harris, and X. Song et al., 2007. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis., 13(1): 97-103.
[8]	Anunnatsiri, S., and P. Tonsawa, 2011. Risk factors and clinical outcomes of multidrug-resistant Acinetobacter baumannii bacteremia at a university hospital in Thailand. Southeast Asian J Trop Med Public Health., 42(3): 693-703.
[9]	Ntusi, N.B.A., M. Badri, H. Khalfey, A. Whitelaw, and S. Oliver et al., 2012. ICU-associated Acinetobacter baumannii colonization/Infection in a high HIV pprevalence resource-poor setting. PLoS ONE 7(12): e52452.
[10]	Jung, J.Y., M.S. Park, S.E. Kim, B.H. Park, J. Y. Son, and E.Y. Kim et al., 2010. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis., 10: 228.
[11]	Emine, A.L.P., M. Yerer, S. Kocagö, G. Metan, and D. Esel et al., 2009. The risk factors and spread of multidrug-resistant Acinetobacter baumannii in intubated patients in a medical intensive care unit. Turk J Med Sci. May., 39 (5): 761-769.
[12]	McGee S., 2002. Simplifying likelihood ratios. J Gen Intern Med., 17(8): 647-650.
[13]	Lee, Y.T., S.C. Kuo, S.P. Yang, Y.T. Lin, and F.C. Tseng et al., 2012. Impact of appropriate antimicrobial therapy on mortality associated with Acinetobacter baumannii bacteremia: relation to severity of infection. Clin Infect Dis., 55 (2): 209-215.
[14]	Dent L.L., D.R. Marshall, S. Pratap, and R.B. Hulette, 2010. Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital. BMC Infect Dis., 10: 196.
[15]	Paterson D.L., 2006. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis., 43 (S2): S43-S48.
[16]	Magiorakos, A.-P., A. Srivasan, R.B. Carey, Y. Carmeli, and M.E. Falagas et al., 2011. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect., 18: 268-281.
[17]	Tjoa. E., L.H. Moehario, A. Rukmana, and R. Rohsiswatmo, 2013. Acinetobacter baumannii: Role in blood stream infection in neonatal unit, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Int J Microbiol., 180763.
[18]	Mahajan. G., S. Sheemar, S. Chopra, J. Kaur, and D. Chowdhary et al., 2011. Carbapenem resistance and phenotypic detection of carbapenemases in clinical isolates of Acinetobacter baumannii. Indian J Med Sci., 65 (1):18-25.
[19]	Lemos, E.V., F.P. de la Hoz, T.R. Einarson, W.F. McGhan, and E. Quevedo et al., 2014. Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and meta-analysis. Clin Microbiol Infect., 20: 416-423.