Clinical and economic outcomes of Acinetobacter vis a vis non-Acinetobacter infections in an Indian teaching hospital

Priyendu, Asim; Naik, Nagappa Anantha; Varma, Muralidhar; Vandana, KE; Varsha, A Prabhu

doi:10.4103/2229-3485.173778

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…15 These infections are associated with high morbidity and mortality and contribute to prolonged hospital stays and high hospital costs. [16][17][18][19] Limitations…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017

Vincent

Sakr

Singer

et al. 2020

JAMA

465

420

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Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies. OBJECTIVE To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide. DESIGN, SETTING, AND PARTICIPANTS Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged Ն18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017. EXPOSURES Infection diagnosis and receipt of antibiotics. MAIN OUTCOMES AND MEASURES Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design). RESULTS Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60]; P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistant Enterococcus (OR, 2.41 [95% CI, 1.43-4.06]; P = .001), Klebsiella resistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63]; P = .03), or carbapenem-resistant Acinetobacter species (OR, 1.40 [95% CI, 1.08-1.81]; P = .01) was independently associated with a higher risk of death vs infection with another microorganism. CONCLUSIONS AND RELEVANCE In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.

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“…15 These infections are associated with high morbidity and mortality and contribute to prolonged hospital stays and high hospital costs. [16][17][18][19] Limitations…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017

Vincent

Sakr

Singer

et al. 2020

JAMA

465

420

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“…Apart from CoNS, the most common pathogens isolated were A. baumanii, Proteus spp., K. pneumoniae , and E. cloacae . These bacteria are often associated with nosocomial infections and high morbidity [ 32 33 ], potentially indicating a nosocomial source of SSI. Although not a traditional pathogen in SSIs, recent studies have reported Acinetobacter as a cause of SSIs in resource-limited settings [ 17 34 35 36 37 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda

Velin

Umutesi

Riviello

et al. 2021

Annals of Global Health

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Background: As the volume of surgical cases in low- and middle-income countries (LMICs) increases, surgical-site infections (SSIs) are becoming more prevalent with anecdotal evidence of antimicrobial resistance (AMR), despite a paucity of data on resistance patterns. Objectives: As a primary objective, this prospective study aimed to describe the epidemiology of SSIs and the associated AMR among women who delivered by cesarean at a rural Rwandan hospital. As secondary objectives, this study also assessed patient demographics, pre- and post-operative antibiotic use, and SSI treatment. Methods: Women who underwent cesarean deliveries at Kirehe District Hospital between September 23rd, 2019, and March 16th, 2020, were enrolled prospectively. On postoperative day (POD) 11 (+/– 3 days), their wounds were examined. When an SSI was diagnosed, a wound swab was collected and sent to the Rwandan National Reference Laboratory for culturing and antibiotic susceptibility testing. Findings: Nine hundred thirty women were enrolled, of whom 795 (85.5%) returned for the POD 11 clinic visit. 45 (5.7%) of the 795 were diagnosed with SSI and swabs were collected from 44 of these 45 women. From these 44 swabs, 57 potential pathogens were isolated. The most prevalent bacteria were coagulase-negative staphylococci (n = 12/57, 20.3% of all isolates), and Acinetobacter baumannii complex (n = 9/57, 15.2%). 68.4% (n = 39) of isolates were gram negative; 86.7% if excluding coagulase-negative staphylococci. No gram-negative pathogens isolated were susceptible to ampicillin, and the vast majority demonstrated intermediate susceptibility or resistance to ceftriaxone (92.1%) and cefepime (84.6%). Conclusions: Bacterial isolates from SSI swab cultures in rural Rwanda predominantly consisted of gram-negative pathogens and were largely resistant to commonly used antibiotics. This raises concerns about the effectiveness of antibiotics currently used for surgical prophylaxis and treatment and may guide the appropriate selection of treatment of SSIs in rural Rwanda and comparable settings.

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“…Infections caused by AB include blood stream infections, ventilator associated pneumonias, urinary tract infections, meningitis, and wound infections (Munoz-Price and Weinstein, 2008 ). These infections are associated with high morbidity and mortality and contribute to a prolonged hospital stay and high hospital costs (Lee et al, 2007 ; Sunenshine et al, 2007 ; Jang et al, 2009 ; Asim et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia

Ballouz

Aridi

Afif

et al. 2017

Front. Cell. Infect. Microbiol.

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Infections caused by Acinetobacter baumannii (AB), an increasingly prevalent nosocomial pathogen, have been associated with high morbidity and mortality. We conducted this study to analyze the clinical features, outcomes, and factors influencing the survival of patients with AB bacteremia. We retrospectively examined the medical records of all patients developing AB bacteremia during their hospital stay at a tertiary care hospital in Beirut between 2010 and 2015. Ninety episodes of AB bacteremia were documented in eighty-five patients. Univariate analysis showed that prior exposure to high dose steroids, diabetes mellitus, mechanical ventilation, prior use of colistin and tigecycline, presence of septic shock, and critical care unit stay were associated with a poor outcome. High dose steroids and presence of septic shock were significant on multivariate analysis. Crude mortality rate was 63.5%. 70.3% of the deaths were attributed to the bacteremia. On acquisition, 39 patients had septicemia. Despite high index of suspicion and initiation of colistin and/or tigecycline in 18/39 patients, a grim outcome could not be averted and 37 patients died within 2.16 days. Seven patients had transient benign bacteremia; three of which were treated with removal of the line. The remaining four did not receive any antibiotics due to withdrawal of care and died within 26.25 days of acquiring the bacteremia, with no signs of persistent infection on follow up. A prolonged hospital stay is frequently associated with loss of functionality, and steroid and antibiotic exposure. These factors seem to impact the mortality of AB bacteremia, a disease with high mortality rate and limited therapeutic options.

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Clinical and economic outcomes of Acinetobacter vis a vis non-Acinetobacter infections in an Indian teaching hospital

Cited by 9 publications

References 24 publications

Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017

Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017

Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda

Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia

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