Emergence of multi-drug-resistantAcinetobacter anitratusspecies in neonatal and paediatric intensive care units in a developing country: concern about antimicrobial policies

Abstract

Antimicrobial abuse is a serious risk factor for the emergence of multi-drug-resistant (MDR) pathogens. We report on the emergence of multi-drug-resistant Acinetobacter anitratus species over two 8-week periods in 1999 in the neonatal and paediatric intensive care units (NICU and PICU) of King Edward VII Hospital, Durban, South Africa. The source, transmission dynamics, microbiological evaluations, antibiotic utilization patterns and outcome were evaluated. MDR Acinetobacter anitratus was isolated from different body sites in 23 infants less than 2 months of age, 18 in the PICU and five in the NICU. The mortality was 56.5% and two survivors required re-admission. Ten of the 23 cases had entered the ICU with MDR Acinetobacter anitratus. Eleven of the study infants had received broad-spectrum antimicrobial agents before entering the ICU, while all infants with nosocomially acquired MDR Acinetobacter anitratus had received broad-spectrum antimicrobial agents. All the surgical cases with MDR Acinetobacter anitratus died. Microbiological data from both ICUs for 1999 indicated that gram-negative bacteria accounted for two-thirds of isolates, Acinetobacter anitratus and Klebsiella pneumoniae accounting for 33% and 27% of the isolates, respectively. Only 53% and 57% of all Acinetobacter spp isolates were susceptible to piperacillin/tazobactam and carbepenems, respectively. MDR Acinetobacter anitratus is an emerging problem to which antimicrobial abuse contributes.

Epidemiology of and Risk Factors for Acinetobacter Species Bloodstream Infection in Children

“…infections in pediatric patients have shown even higher levels of nonsusceptibility to ciprofloxacin (99 -100%), 11,25 and to thirdgeneration cephalosporins (92-100%), 11,21,25 ticarcillin/clavulanate (96%), 11 and imipenem (62-100%). 8,11 Previous pediatric studies have not examined resistance to TMP-SMX. Unlike our study, Gales et al 9 found that the frequency of resistance to antibiotics in hospital-acquired Acinetobacter spp.…”

Ventilator‐associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence

“…Little attention has been given to the aetiology, prevention and management of paediatric VAP in South Africa, with only one paper published in the last 10 years relating to nosocomial infection in South African PICUs 9 . This is the first study to specifically investigate VAP in the context of a South African PICU with high HIV prevalence.…”

Antibiotic Resistance in Neonatal Intensive Care Unit Pathogens: Mechanisms, Clinical Impact, and Prevention Including Antibiotic Stewardship

“…[54] Jeena et al described a multi-drug resistant Acinetobacter anitratus outbreak in a pediatric and neonatal ICU causing 23 infections, primarily post-operative infections and pneumonia, with a 57% mortality rate. [55] Birth weight < 1000 grams and receipt of prolonged antibiotic therapy (>21 days) have been associated with increased risk of infections caused by antibiotic resistant GNB. In developing countries, where GNB cause a larger proportion of neonatal sepsis than in developed countries, the burdens of resistance are even greater.…”