• Ki Tae Kwon, Won Sup Oh, Jae-Hoon Song, Hyun-Ha Chang, Sook-In Jung, Shin-Woo Kim, Seong Yeol Ryu, Sang Taek Heo, Dong Sik Jung, Ji-Young Rhee, Sang Yop Shin, Kwan Soo Ko, Kyong Ran Peck, and Nam Yong Lee.
• Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Seoul 135-710, Korea.
• J. Antimicrob. Chemother. 2007 Mar 1;59(3):525-30.

ObjectivesTo investigate the impact of imipenem resistance on the mortality rate among patients with Acinetobacter bacteraemia.MethodsA retrospective, pairwise-matched (1:1), risk-adjusted (age, Pitt bacteraemia score) cohort study was performed at three tertiary care hospitals in Korea from January 2000 to June 2005.ResultsForty patients with imipenem non-susceptible Acinetobacter bacteraemia (INAB group) and 40 matched subjects (1:1 ratio) with imipenem-susceptible Acinetobacter bacteraemia (ISAB group) were included. Both groups had similar clinical features related to the severity of illness. The 30 day mortality rate was higher in the INAB group (57.5%) than the ISAB group (27.5%) (P = 0.007). The rate of discordant antimicrobial therapy was higher in the INAB group (65.0%) than the ISAB group (20.0%) (P < 0.001). The 30 day mortality rate was higher in the patients with discordant antimicrobial therapy (67.6%) than concordant antimicrobial therapy (23.9%) (P < 0.001). Multivariate analysis showed that age, the Pitt bacteraemia score, immunosuppressive status, and discordant antimicrobial therapy were independent risk factors for 30 day mortality among patients with Acinetobacter bacteraemia (P < 0.05). When discordant antimicrobial therapy was excluded in the multivariate analysis, the imipenem resistance was associated with 30 day mortality (P = 0.005).ConclusionsImipenem resistance has a significant impact on the mortality rate among patients with Acinetobacter bacteraemia, and this is mainly attributable to the higher rate of discordant antimicrobial therapy.

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