Acinetobacter baumannii bloodstream infections in a tertiary hospital: Antimicrobial resistance surveillance

Al-Mously, Najwa

doi:10.3396/ijic.v9i2.012.13

Cited by 11 publications

(15 citation statements)

References 17 publications

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“…The results of our study reveal three main findings. First, the percentage of MDR-AB in our study was 98.3% of all VAP cases, which is higher than previously reported in VAP (20%-80.5%) [12,22,23] and other nosocomial infections (15.7%-75%) [10,[24][25][26] in different countries. Second, independent predictors of 14-day mortality in MDR-AB VAP patients were an inadequate number of definitive therapies and not using nebulized Consistent with previous studies [11], an inadequate number of definitive treatments was identified as one of the independent factors associated with higher mortality in the present study.…”

Section: Discussioncontrasting

confidence: 76%

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Almomani

McCullough

Gharaibeh

et al. 2015

J Infect Dev Ctries

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Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017-0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028-0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.

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Section: Discussioncontrasting

confidence: 76%

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Almomani

McCullough

Gharaibeh

et al. 2015

J Infect Dev Ctries

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“…In our study, the resistance to imipenem was 76.19% throughout the hospital and 87.7% in the ICUs. This rate is lower than that noted in India, where the resistance to imipenem reached 89.6% [ 20 ] and higher than those of previous studies in Morocco: 23.6% [ 22 ] in 2001, 42.6% in 2005 [ 7 ] and those obtained in the United States and Saudi Arabia, where the resistance to imipenem was 44.7% and 61.3% respectively [ 18 , 21 ]. Carbapenem resistance in A. baumannii is often due to the expression of OXA carbapenemase types, Metallo-beta-lactamases (MBL) carbapenemase and the impermeability associated with mutations altering the expression of porins and efflux pumps [ 3 , 30 ].…”

Section: Discussioncontrasting

confidence: 59%

“…The resistance to colistin was confirmed by the determination of the Minimum Inhibitory Concentrations (MICs) using the E-test method (Biomérieux, Marcy l'Etoile, France) according to the manufacturer′s recommendations. All isolates of Acinetobacter resistant to three or more classes of antibiotics represented by piperacillin / tazobactam, ceftazidime, imipenem, ciprofloxacin, aminoglycosides and colistin were considered as MDR [ 18 , 21 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

“…According to the literature data, the resistance rate varies from 31.8 to 92.1% to ceftazidime; 8.8 to 89.9% vs imipenem, from 12.2 to 89.9% vs Piperacillin / Tazobactam, from 28.8 to 91.6% vs fluoroquinolones and 30 to 90.3% vs aminoglycosides [ 8 , 17 – 20 ] but colistin is often the only effective treatment option whereas some Acinetobacter strains develop resistance to colistin [ 8 , 18 – 21 ]. Resistance to colistin was estimated to 5.3% in the United States [ 21 ]; 2.7% in South Africa [ 8 ]; 1.2% in India [ 20 ] and 0.9% in Tunisia [ 19 ] and 0.5% in Saudi Arabia [ 18 ]. In Morocco, the Acinetobacter's antibiotic resistance rates were of 50.3 to 68.7% for ceftazidime, 23.8 to 42.6% for the imipenem, 17 to 77.5% for aminoglycosides, 65 to 68% for ciprofloxacin and no clinical isolates were resistant to colistin [ 6 , 7 , 22 ] however these data were inadequate and old.…”

Section: Introductionmentioning

confidence: 99%

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Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

Uwingabiye¹,

Frikh²,

Lemnouer³

et al. 2016

Pan Afr Med J

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IntroductionThis study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat.MethodsThis is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014.ResultsDuring the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n = 6352) and 9.6% of Gram negative rods (n = 4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin.ConclusionThis paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.

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“…Imipenem (61.3%) and meropenem (3.9%) also revealed high resistance rates. Out of the total, 104 (78.8%) of these multi-drug resistant (MDR) strains were sensitive only to colistin and tigecycline (Al-Mously, 2013).…”

Section: Most Common Pathogens Isolatedmentioning

confidence: 99%

Epidemiology of bloodstream infection in Saudi Arabia

Ozbak¹

2018

Afr. J. Microbiol. Res.

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Bloodstream infections are a challenge to clinicians due to high rates of morbidity and mortality. Moreover, rational antimicrobial therapy, if promptly started, can improve the prognosis of sepsis. The gold-standard blood culture has some limitations and it takes time to complete (about 2-5 days). This leaves the clinicians to start immediately broad-range antimicrobial therapy until microbiology culture's results available that may lead to complicate situation of patient further. Therefore, there is an urgent need for the development of more advanced diagnostic approaches that can overcome limitations of culture-based methods. This review gives an overview of the BSIs and its epidemiology over several cities and hospitals in Saudi Arabia. It also encompasses the diverse molecular diagnostic modalities developed for the rapid detection and identification of BSIs. Furthermore, the growing understanding of the host's inflammatory responses to infections has led to the discovery of immunological biomarkers as diagnostic tools for sepsis-related BSI. The rational use of immunological and molecular diagnostic markers in clinical settings may speed up diagnosis and prognosis of septic patients. This review shows that the percentage of BSIs in Saudi Arabia, from 1983 to 2015, ranges from 1% to 11% among patients with confirmed infection. It also indicated that Staphylococcus aureus and coagulase negative staphylococci (CoNS) were the most common Gram-positive pathogens; while Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most Gram-negative ones from patients with BSI. The recommendation of this review is to initiate new surveillance systems of BSI in different regions and hospitals in Saudi Arabia and determining the antibiotic susceptibility profile to design antibiograms that may improve the antibiotic stewardship program for treating BSIs. A comparative study should be conducted for patients suspected to have sepsis, using the standard blood cultures, immunological markers and rapid molecular assays to set up a panel to help diagnose BSIs rapidly. This will allow early and optimal patient management and treatment in Saudi Arabia and therefore decrease overall healthcare costs.

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Acinetobacter baumannii bloodstream infections in a tertiary hospital: Antimicrobial resistance surveillance

Cited by 11 publications

References 17 publications

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

Epidemiology of bloodstream infection in Saudi Arabia

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