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

摘要

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.