Acinetobacteria Baumanni Infection in the Intensive Care Unit–Risk Factors and Antibiotic Resistance

Year 2022, Volume: 3 Issue: 1, 55 - 60, 15.01.2022

Barış Çil , Evrim Kütük Mehmet Kabak , İclal Hocanlı , Tekin Yıldız

Abstract

BACKGROUND: The rate of hospital infections are 5 – 10 times higher in he intensive care unit compared to inpatient clinics.MATERIALS & METHOD: The bacterial cultural analysis have been conducted to all patients and 70 subjects that were positive for acinetobacter baumanniicolonisation have been included in the analysis. The data on age, gender, smoking, comorbidities, steroid usage and antibiotic treatment within the first 24 hours has been recorded in the analysis. Septic shock patients who did not respond to intense fluid replacement and needed dopamine infusion for the treatment of hypotension were also interpreted. The results of antibiogram culture, duration of non-invasive and invazive mechanical ventilation, hospital stay and mortality information have all been investigated for the analyis. The APACHE and SOFA scores of the first admission day have been calculated. RESULTS: Invasive mechanical ventilation has been conducted to 66 patients and the median duration of administration was 19.5±23.94 (1-138, range: 138) days. The APACHE II score was 24.69±8.37 and SOFA score was 10.43±3.42. The mean hospital stay was 26.03±24.23 (1-139, range 138) days. The mean time of observing positive culture from hospital admission was 15.55±1.19 days. The distribution of 84 samples were as follows: n=40 (47.6) from blood, n=26 (31%) deep tracheal aspiration material, n=7 (8.3%) from urine, n=7 (8.3%) from wound, n=4 (4.8%) from catheter. CONCLUSION: The antimicrobial regimen must be reassigned according to bacterial culture results. Increased carbapenem resistance is currently trending and this causes longer duration of hospital stay and increased mortality.

Keywords

A. baumannii, antibiotics resistance, intensive care unit

References

• 1. Wong D, Nielsen TB, Bonomo R A, Pantapalangkoor P, Luna B, and Spellberg B. Clinical and pathophysiological overview of Acinetobacter infections: a century of challenges. Clin Microbiol. 2017;30:409–447.
• 2. Neidell MJ, Cohen B, Furuya Y, Hill J, Jeon CY, Glied S, Larson EL. Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin Infect Dis. 2012 Sep;55(6):807-15.
• 3. Tüfek A, Tekin R, Dal T, Tokgöz O, Doğan E, Kavak G, Hoşoğlu S. Evaluation of hospital infections developing in intensive care unit during a decade and review of literature.Dicle Medical Journal. 2012;39:492-498.
• 4. Martín-Aspas A, Guerrero-Sánchez FM, García-Colchero F, Rodríguez-Roca S, Girón-González JA. Differential characteristics of Acinetobacter baumannii colonization and infection: risk factors, clinical picture, and mortality. Inf. Drug Resist. 2018;11: 861–872.
• 5. Harding CM, Hennon SW, Feldman MF. Uncovering the mechanisms of Acinetobacter baumannii virulence. Nat. Rev. Microbiol. 2018; 16:91–102.
• 6. Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int. J. Antimicrob. Agents 2016;47:317–323.
• 7. WHO. Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics. Available online: https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/ (accessed on 20 April 2020).
• 8. Kim YJ, Kim S, Hong KW, Kim YR, Park YJ, Kang MW. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: Impact of appropriate antimicrobial therapy. J. Korean Med. Sci. 2012; 27: 471–475.
• 9. Ayobami O, Willrich N, Harder T, Okeke IN, Eckmanns T, Markwart R. The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis. Emerg Microbes Infect. 2019;8(1):1747-1759.
• 10. Leão A C, Menezes PR, Oliveira MS, Levin AS. Acinetobacter spp. are associated with a higher mortality in intensive care patients with bacteremia: a survival analysis. BMC Infect. Dis. . 2016; 16:386.
• 11. Jang TN, Lee SH, Huang CH, Lee CL, Chen WY. Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit: a case-control study. J. Hosp. Infect. 2009;73:143–150.
• 12. Lahmer T, Messer M, Schnappauf C, Schmidt A, Schmid RM, Huber W. Acinetobacter baumannii sepsis is fatal in medical intensive care unit patients: six cases and review of literature. Anaesth. Intensive Care. 2014; 42:666–668.
• 13. Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Predictors of hospital mortality among septic ICU patients with Acinetobacter spp. bacteremia: a cohort study. BMC Infect. Dis.2014;14:572.
• 14. Gao J, Zhao X, Bao Y, Ma R, Zhou Y, Li X, Chai T, Cai Y. Antibiotic resistance and OXA-type carbapenemases-encoding genes in airborne Acinetobacter baumannii isolated from burn wards. Burns. 2014 Mar;40(2):295-9.
• 15. Munoz-Price LS, Fajardo-Aquino Y, Arheart KL, Cleary T, DePascale D, Pizano L, Namias N, Rivera JI, O'Hara JA, Doi Y. Aerosolization of Acinetobacter baumannii in a trauma ICU*. Crit Care Med. 2013 Aug;41(8):1915-8.
• 16. Custovic A, Smajlovic J, Tihic N, Hadzic S, Ahmetagic S, Hadzagic H. Epidemiological Monitoring of Nosocomial Infections Caused by Acinetobacter Baumannii. Med Arh. 2014;68: 402–6.
• 17. Peleg AY, Seifert H, Paterson DL. 2008. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 21:538–582.
• 18. World HealthOrganization. 2017. Central Asian and Eastern European surveillance of antimicrobial resistance. Annual report 2017. World Health Organization Regional Office for Europe, Copenhagen, Denmark.
• 19. Doi Y, Murray GL, Peleg AY. Acinetobacter baumannii: evolution of antimicrobial resistance-treatment options. Semin Respir Crit Care Med. 2015 Feb;36(1):85-98.
• 20. Lemos EV, de la Hoz FP, Einarson TR, McGhan WF, Quevedo E, Castañeda C, Kawai K. Carbapenem resistance and mortality in patients with Acinetobacter baumannii infection: systematic review and meta-analysis. Clin Microbiol Infect. 2014 May;20(5):416-23.
• 21. Cai Y, Chai D, Wang R, Liang B, Bai N. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother. 2012;67: 1607–15.
• 22. Harmanci A, Harmanci Ö, Akova M. Hospital acquired pneumonia: challenges and options for diagnosis and treatment. Journal of Hospital Infection 2002; 51: 160-7.
• 23. Jones RN: Resistance patterns among nosocomial pathogens. Trends over the past few years, Chest 2001;119 (Suppl 2): S 397-404).
• 24. Garcia-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jimenez-Jimenez FJ, Perez-Paredes C, Barrero-AlmodovarAE, Gili-Miner M (2001) Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: A cohort study. Clin Infect Dis 33: 939–946.
• 25. Townsend J, Park AN, Gander R, Orr K, Arocha D, Zhang S, Greenberg DE. Acinetobacter infections and outcomes at an academic medical center: a disease of long-term care. Open Forum Infect Dis. 2015 Mar 12;2(1):ofv023.
• 26. Ye JJ, Huang CT, Shie SS, Huang PY, Su LH, Chiu CH, Leu HS, Chiang PC. Multidrug resistant Acinetobacter baumannii: risk factors for appearance of imipenem resistant strains on patients formerly with susceptible strains. PLoS One. 2010 Apr 1;5(4):e9947.
• 27. Wah-Shing Leung, Chung-Ming Chu, Kay-Yang Tsang, Fu-Hang Lo, King-Fan Lo and Pak-Leung Ho Chest 2006; 129; 102-109.