Risk Factors For Nosocomial Pan Drug Resistant Acinetobacter Baumannii Infections

Yıl 2019, Cilt: 3 Sayı: 3, 254 - 260, 26.10.2019

Havva Tünay , Tuna Demirdal , Neşe Demirtürk

https://doi.org/10.30565/medalanya.543371

Cited By: 2

Öz

Aim: Acinetobacter baumannii is an important nosocomial pathogen. The purpose of this study was to identify risk factors and mortality of nosocomial infections caused by pan drug resistant (PDR) Acinetobacter baumannii and to characterize their effects on mortality.

Patients and Methods: This study was performed at the Afyonkarahisar Helath Science University, Faculty of Medicine. Nosocomial infections were defined accor-ding to the American Center for Disease Control (CDC). Patients with nosocomial infections caused by Acinetobacter baumannii were included in the study. Patients identified as PDR Acinetobacter baumannii and non-PDR Acinetobacter baumannii infection were com-pared in terms of risk factors.

Results: Two different groups were constructed, one group consisting of 145 PDR and the other of 145 non-PDR Acinetobacter baumannii cases. Stay history in an internal intensive care unit (p=0.001), their duration of hospital stay (p=0.031), renal disease (p=0.003), mechanical ventilation (p=0.001), prior usage history of carbap-enem (p=0.001), presence of nosocomial pneumonia (p=0.001), were independent risk factors associated with PDR Acinetobacter baumannii infections. The mortality rate for the PDR group was 61.8% and it was 38.2% in the non-PDR group (p=0.008).

Conclusion: PDR Acinetobacter baumannii infections are important nosocomial in-fections with a high mortality rate. Patients’ carbapenem usage, stay history in an internal intensive care unit, renal comorbid diseases, and a diagnosis of nosocomial pneumonia are important risk factors for PDR Acinetobacter baumannii infections. In nosocomial infections caused by PDR Acinetobacter baumannii, many risk factors were modifiable. 

Anahtar Kelimeler

Acinetobacter baumannii, antibiotic resistance, antimicrobial therapy

Hastane Kaynaklı Pan Drug Resistant Acinetobacter Baumannii Enfeksiyonlarında Risk Faktörleri

Öz

Amaç: Acinetobacter baumannii, önemli nozokomiyal bir patojendir. Bu çalışmanın amacı, pan drug resistant (PDR) Acinetobacter baumannii nedenli nosokomiyal enfeksiyonlar için risk faktörlerinin ve mortalite üzerine olan etkinin tanımlanmasıdır. 

Hastalar ve Yöntemler: Çalışma Afyon Kocatepe Üniversitesi Tıp Fakültesi’nde gerçekleştirilmiştir. Amerikan Hastalık Kontrol Merkezi (CDC) tanı kriterlerine göre tanımlanmıştır. Acinetobacter baumannii nedenli nozokomiyal enfeksiyon tanımlanan hastalar çalışmaya dahil edilmiştir. PDR Acinetobacter baumannii ve non-PDR Acinetobacter baumannii enfeksiyonu saptanan olgular risk faktörleri yönünden karşılaştırılmıştır 

Bulgular: Biri 145 PDR diğeri 145 PDR olmayan Acinetobacter baumannii vakalarından oluşan iki farklı grup oluşturuldu. Dahili yoğun bakım ünitesinde yatış öyküsü (p=0,001), hastanede kalış süresi PDR grupta ortalama 28,2±23,0 (p=0,031), renal hastalık (p=0,003), mekanik ventilasyon (p=0,001),önceden karbapenem kullanma öyküsü (p=0,001), nozokomiyal pnömoni varlığı, (p=0,001 bağımsız risk faktörü olmuştur. Mortalite oranı PDR grupta % 61,8, non-PDR grupta % 38,2, olarak belirlenmiştir (p=0,008). 

Sonuç: PDR Acinetobacter baumannii enfeksiyonları mortalite oranı yüksek önemli nozokomiyal infeksiyonlardır. Dahili yoğun bakım ünitesinde yatış öyküsü, hastanede kalış süresi, renal hastalık, mekanik ventilasyon, karbapenem kulanım öyküsü, nozokomiyal pnömoni varlığı, solunum sekresyon örneği PDR Acinetobacter baumannii enfeksiyonu için önemli risk faktörleridir. PDR Acinetobacter baumannii nedenli nozokomiyal enfeksiyonlarda çoğu risk faktörleri düzeltilebilir özelliktedir. 

Anahtar Kelimeler

Acinetobacter baumannii, antibiyotik direnci, antimikrobiyal tedavi

Kaynakça

• 1. Allen DM, Hartman BJ. Acinetobacter species. In: Mandell GL, Bennet JE, Dolin R, eds. Principles and practice of ınfectious diseases. Philadelphia: Churchill Livingstone, Elsevier; 2010. p. 2881-85.
• 2. Morgan DJ, Liang SY, Smith CL et al.(2010) Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves, gowns, and hands of healthcare workers. Infection Control Hosp Epidemiol. 2010;31(7):716–21. PMID: 20486855
• 3. Giamarellou H, Antoniadou A, Kanellakopoulou K. Acinetobacter baumannii: a universal threat to public health? Int J of Antimicrob Agents. 2008;32(2):106-19. PMID: 18571905
• 4. Chan PC, Huang LM, Lin HC et al. Control of an outbreak of pandrug-resistant Acinetobacter baumanni colonization and infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2007;28(4):423-29. PMID: 17385148
• 5. Jang TN, Lee SH, Huang CH et al. 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(2):143-50. PMID: 19716203
• 6. Deris ZZ, Shafei MN, Harun A. Risk factors and outcomes of imipenem-resistant Acinetobacter bloodstream infection in north-eastern Malaysia. Asian Pacific J Trop Biomed. 2011;1(4):313-15. PMID: 23569782
• 7. Baran G, Erbay A, Bodur H et al. Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. Int J Infect Dis. 2008;12(1):16-21. PMID: 17513154
• 8. Paterson DL, Doi Y. A Step Closer to Extreme Drug Resistance (XDR) in Gram-Negative Bacilli. Clin Infect Dis. 2007;45(9):1179-81. PMID: 17918079
• 9. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309‐32. PMID: 18538699
• 10. Inan A, Ozgultekin A, Akcay SS et al. Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care ünit of a teaching hospital in İstanbul(2004-2010). Jpn J Infect Dis. 2012;65:146-51. PMID: 22446122
• 11. Vincent JL, Rello J, Marshall J et al. International study of the prevalence and outcomes of infection in intensive care units: results of the European prevelance of infection in intensive care (EPIC II) study. JAMA. 2009;302(21):2323-29. PMID: 19952319
• 12. Chang HC, Chen YC, Lin MC et al. Mortality risk factors in patients with Acinetobacter baumannii ventilator-associated pneumonia. J Formos Med Assoc. 2011;10:564-71. PMID: 21930066
• 13. Gupta A, Agrawal A, Mehrotra S et al. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia. Indian J Crit Care Med. 2011;15(2):96-101. PMID: 21814373
• 14. Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients—risk factors for acquisition, infection and their consequences. J Hosp Infect. 2007;65(3):204–11. PMID: 1725466
• 15. Sheng WH, Liao CH, Lauderdale TL et al. A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii. Int J Infect Dis. 2010;14(9):764-69. PMID: 20646946
• 16. Metan G, Sariguzel F, Sumerkan B. Factors influencing survival in patients with multi-drug-resistant Acinetobacter bacteraemia. Euro J Int Med. 2009;20(5):540-44. PMID: 19712862
• 17. Kim YJ, Kim SI, Hong KW et al. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: ımpact of appropriate antimicrobial therapy. J Korean Med Sci. 2012;27(5):471-75. PMID: 22563209
• 18. Aydemir H, Celebi G, Piskin N et al. Mortality attributable to carbapenem-resistant nosocomial Acinetobacter baumannii infections in a Turkish university hospital. J Infect Dis. 2012;65(1): 66-71. PMID: 22563209
• 19. Song YJ, Kee SY, Hwang IS et al. In vitro activities of carbapenem/sulbactam combination, colistin, colistin/rifampicin combination and tigecycline against carbapenem-resistant Acinetobacter baumannii. J Antimicrob Chemother. 2007; 60:317-22. PMID: 22563209
• 20. Lim TP, Tan TY, Lee W et al. In-vitro activity of polymyxin B, rifampicin, tigecycline alone and in combination against carbapenem-resistant Acinetobacter baumannii in Singapore. 2011;21;6(4),18485. PMID: 21533030
• 21. Rahal JJ. Novel antibiotic combinations against infections with almost completely resistant Pseudomonas aeruginosa and Acinetobacter species, Clin Infect Dis. 2006;1(43):95-9. PMID: 16894522
• 22. Stroup JS, Mitchell K, Hitzeman D. Novel treatment approach to combat an infection with Acinetobacter. Bayl Univ Med Cent. 2010;23:29-30. PMID: 20157502
• 23. Wareham DW, Gordon NJ, Hornsey M. In vitro activity of teicoplanin combined with colistin versus multidrug-resistant strains of Acinetobacter baumannii. J Antimicrob Chemother. 2011;66(5):1047-51. PMID: 21393131
• 24. Enoch DA, Summers C, Brown NM et al. Investigation and management of an outbreak of multidrug-carbapenem-resistant Acinetobacter baumannii in Cambridge, UK. J Hospital Infect. 2008;70(2):109-18. PMID: 18701189
• 25. Wybo I, Blommaert L, De Beer T et al. Outbreak of multidrug-resistant Acinetobacter baumannii in a Belgian university hospital after transfer of patients from Greece. J Hosp Infect. 2007;67(4):374-80. PMID: 18023922