Risk factors for multi-drug resistant Acinetobacter baumanniibacteremia in patients with colonization in the intensive care unit

Abstract

BackgroundEpidemic outbreaks of multi-drug resistant (MDR) Acinetobacter baumannii (AB) in intensive care units (ICUs) are increasing. The incidence of MDR AB bacteremia, which develops as a result of colonization, is increasing through widespread dissemination of the pathogen, and further colonization. We sought to determine risk factors for MDR AB bacteremia in patients colonized with MDR AB in the ICU.MethodsWe conducted a retrospective, observational study of 200 patients colonized with MDR AB in the ICU at Severance Hospital, South Korea during the outbreak period between January 2008 and December 2009.ResultsOf the 200 patients colonized with MDR AB, 108 developed MDR AB bacteremia, and 92 did not. APACHE II scores were higher in bacteremic than non-bacteremic patients at the time of ICU admission and colonization (24.0 vs. 21.6; P = 0.035, 22.9 vs. 16.8; P < 0.001, respectively). There was no difference between the two groups in the duration of time from ICU admission to colonization (7.1 vs. 7.2 days; P = 0.923), but the duration of time at risk was shorter in bacteremic patients (12.1 vs. 6.0 days; P = 0.016). A recent invasive procedure was a significant risk factor for development of bacteremia (odds ratio = 3.85; 95% CI 1.45-10.24; P = 0.007). Multivariate analysis indicated infection and respiratory failure at the time of ICU admission, maintenance of mechanical ventilation, maintenance of endotracheal tube instead of switching to a tracheostomy, recent central venous catheter insertion, bacteremia caused by other microorganism after colonization by MDR AB, and prior antimicrobial therapy, were significant risk factors for MDR AB bacteremia.ConclusionsPatients in the ICU, colonized with MDR AB, should be considered for minimizing invasive procedures and early removal of the invasive devices to prevent development of MDR AB bacteremia.

Patient Demographics and Characteristics of Infection with Carbapenem-Resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; in a Teaching Hospital from the United States

“…The risk of developing repeat isolate resistant to carbapenems increased significantly with ventilator use. Invasive procedures have been associated with the multidrug resistance [7]. Diabetes and prior surgery, which were not significantly associated with overall resistance, were major risk factors in developing resistance in a second (or repeat) isolate.…”

“…Pneumonia caused by A. baumannii is associated with contaminated or colonized surgical and respiratory equipment. Outbreaks of A. baumannii have been reported in hospitals; especially in intensive care units (ICUs) [7]. Its status as an opportunistic organism makes it an unpredictable nosocomial pathogen that can cause significant mortality in such cases [8][9][10].…”

Chracteristics of acinetobacter baumanii isolated patients with respiratory samples in intensive care unit

“…Acinetobacter enfeksiyonu için çalışmalarda belirlenen diğer temel risk faktörleri geniş spektrumlu antibiyotik kullanımı, öncesinde enfeksiyon, total parenteral beslenme ve invaziv prosedürlerin varlığı (periferik damar, arteryel ve santral venöz katater, mekanik ventilasyon, nazogastrik tüp, üriner katater) şeklinde belirtilmiştir (16)(17)(18)(19)(20) . Bizim de çalışmamızda saptadığımız risk faktörleri, öncesinde ve sonrasında kültürlerde üreme (Tablo 1), öncesinde antibiyotik kullanmı, idrar sondası, mekanik ventilasyon, nazogastrik sonda, total parenteral beslenme, santral venöz katater, transfüzyon öyküsü gibi invaziv prosedürler şeklinde saptandı.…”

Comparison of the Antibacterial Effects of Nanosilverwith18 Antibiotics on Multidrug Resistance Clinical Isolates of Acinetobacter baumannii

“…They have been involved in a variety of nosocomial infectious diseases. Acinetobacter baumannii has become a particularly important organism in the Intensive Care Unit (ICU) (3). Infections occur in the respiratory and urinary tract, peritoneum, surgical wounds, skin and eyes.…”

“…Bacteremia and secondary meningitis with mortality rates from 20% to 27% were seen in several cases (1). They have been reported to be thecommon agents of nosocomial pneumonia, particularly ventilator-associated pneumonia (VAP) in hospital ICUs (3,4).…”