Carbapenem-resistant Acinetobacter baumannii in Adult Intensive Care Units: Risk Factors for Colonization and Infection

Abstract

Giriş: Karbapenem dirençli Acinetobacter baumannii (KDAB) izolatları yoğun bakım ünitelerinde (YBÜ) ciddi tehditlerdendir. Bu çalışmada yetişkin yoğun bakım hastalarında KDAB kolonizasyonu ve enfeksiyonu ile ilişkili risk faktörlerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Cerrahi/medikal YBÜ'de 48 saatten fazla hastaneye yatırılan hastalar KDAB edinimi için tarandı. Çevre kültürleri alındı. Tanımlama ve antibiyotik duyarlılığı Vitek 2 (bioMérieux, Fransa) ile belirlendi. bla OXA-23 , bla OXA-40 , bla OXA-51 ve bla OXA-58 genleri, bir multipleks polimeraz zincir reaksiyonu (Hyplex® CarbOxa ID, Almanya) ile araştırıldı. DiversiLab (bioMérieux, Fransa) klonal ilişki analizi için kullanıldı. Verilerin karşılaştırılması için ki-kare ve t-testi kullanıldı. Lojistik regresyon geriye LR modeli, YBÜ KDAB edinimi ile bağımsız olarak ilişkili faktörleri değerlendirmek için yapıldı. ÖzIntroduction: Carbapenem-resistant Acinetobacter baumannii (CRAB) isolates are serious threats in intensive care units (ICUs). In this study, we aimed to investigate the risk factors associated with CRAB colonization and infection among adult ICU patients. Materials and Methods: Patients hospitalized in the surgical/medical ICU for more than 48 hours were screened for CRAB acquisition. Environmental cultures were also performed. Identification and antibiotic susceptibility were determined with Vitek 2 (bioMérieux, France). bla OXA-23 , bla 0XA-40 , bla OXA-51 and bla OXA-58 genes were investigated by a multiplex polymerase chain reaction (Hyplex® CarbOxa ID, Germany). DiversiLab (bioMérieux, France) was used for clonal relationship analysis. Chi-square and t-test were used for comparison of data. Logistic regression backward LR model was performed to assess factors independently associated with ICU CRAB acquisition. Results: Three hundred and ten patients were screened and 103 (33.2%) were found to be colonized with CRAB. bla OXA-23 and bla OXA-51 genes were found to be positive in all. DiversiLab showed that majority of the isolates came from a single clone. Clinical infection versus asymptomatic carriage ratio was approximately 1:2. Status of unconsciousness [p=0.049, OR: 2.37 (95% CI: 1.35-4.14)], staying ≥15 days in ICU [p=0.000, OR: 6.55 (95% CI: 3.70-11.61)], and prior history of carbapenem use [p=0.003, OR: 2.45 (95% CI: 1.36-4.41) were found to be the independent risk factors for CRAB colonization. When multivariate analysis was performed for risk factors for A. baumannii infections, CRAB colonization [p=0.000, OR: 8.25 (95% CI: 3.51-19.40), mechanical ventilator use [p=0.016, OR: 3.38 (95% CI: 1.25-9.149)], staying ≥15 days in ICU [p=0.000, OR: 11.17 (95% CI: 3.59-34.71)], and prior history of carbapenem use [p=0.000, OR: 2.63 (95% CI: 1.19-5.86)] were detected as independent risk factors. Conclusion: CRAB colonization leads to infection. Taking the necessary precautions in ICUs before colonization is important. AbstractNeriman AKSU

Risk Factors Associated with Mortality in Acinetobacter baumannii Infections: Results of a Prospective Cohort Study in a Tertiary Public Hospital in Guayaquil, Ecuador

“…It was evident that the mortality risk factors in patients with hospital-acquired infections caused by CRAB were exposure to IMV, having been treated in other hospital units, and having been medicated with carbapenems. At the public hospital of Turkey, the risk factors of Acinetobacter baumannii resistance to infection with carbapenems found in the analysis showed that the use of IMV had a rank of p = 0.016; stays shorter than 15 days in the ICU had a rank of p < 0.001; and a history of using carbapenems had a rank of p < 0.001, among other independent risk factors [ 34 ]. The multicenter study carried out in Turkey showed that long-term supply of drugs at the ICU, bacteremia associated with ventilation, use of third-generation cephalosporins before the diagnosis of an infection, and liver cirrhosis were important risk factors in the mortality of patients infected with Acinetobacter baumannii [ 30 ].…”